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Alcohol Free Forever

This powerful guide walks you step-by-step through exactly what you need to do to free yourself from your alcohol addiction without going through AA meetings or expensive sessions. There are three main types of relaxation techniques you can practice when you feel upset and stressed. If you practice regularly, they will become part of your lifestyle and you may find yourself habitually more relaxed as a result. Part 2 will exercise Neuro Linguistic Programming to release thoughts and a technique of progressive muscle relaxation also negative situations. Because of the mind body connection, exercises to relax the body will also flow through the mind. Much of the stress we feel is because of our resistance to certain feelings or emotions. Alcohol Free Forever is a lifesaver ebook. This guide was extremely eye-opening and the daily emails make it extremely easy to quit and to establish a routine that did not involve alcohol. Continue reading...

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Other Surveillance Systems

In 1850, Lemuel Shattuck issued a report that linked infant and maternal mortality to communicable disease. He recommended a decennial (every 10 years) census, standardization of disease and death terminology, and collection of health data by demographics. He also applied his recommendations to program activities, such as immunization, school health, and smoking and alcohol abuse (Thacker, 2000).

Project Title Alcohol Induced Immunomodulationretroviral Cardiopath

Summary Cardiomyopathy and left ventricular dysfunction are prevalent in people with AIDS or chronic alcohol use. However almost nothing is known of the combined effects of retroviral infection plus alcohol on heart disease. Our murine retrovirus infection mimics much of the cytokine dysregulation found during HIV infection, prompting inflammatory damage for cardiac toxicity. We found that alcohol consumption exacerbated many immune, oxidative, and nutritional defects due to murine retrovirus infection. We found that alcohol + retrovirus exposure was particularly toxic, increasing Th2 and reducing Th1 cytokines, dramatically lowering cardiac vitamin E, increasing oxidation of cardiac lipids and synergistically promoting severe heart damage due to Coxsackie B3 infection. Our overall hypothesis is that the combination of ethanol + retroviral infection induces immune dysfunction and oxidation for increased cardiovascular disease. These effects should promote growth and pathogenesis of...

General Methodological Considerations Of Observational Studies

With the exception of experimental studies, epidemiologic research is based on observational studies, and as such, in theory prone to bias by ''confounding.'' Confounders are ''extraneous factors'' that may lead to an apparent (or conceal a true) association between putative risk factors (or protective factors) and disease, due to their own association with both the former and the latter. For example, various lifestyle factors, such as dietary habits, physical activity, smoking and alcohol consumption, which are clearly related to a variety of health outcomes at old age, are often also interrelated. Therefore, when the impact of one of these factors on some health outcome is assessed, it is crucial that the other factors, as well as additional relevant factors, such as age or gender, are carefully measured and controlled for in the analysis. Control for confounding is typically done by means of multivariable analysis, such as multiple logistic regression or the Cox proportional...

Cardiovascular Disease

Regarding etiology and risk factors, three major types of stroke have to be distinguished ischemic stroke (IS), intracerebral hemorrhage (ICH), and sub-arachnoid hemorrhage (SAH), accounting for about 88 , 9 , and 3 of all strokes, respectively (American Heart Association, 2005). Major modifiable risk factors for IS identified in large-scale epidemiologic case-control and cohort studies include hypertension, diabetes, lack of physical activity, smoking and coronary artery disease (Boden-Albala and Sacco, 2004). Hypertension is clearly the most important modifiable risk factor for IS, but other factors, including heavy alcohol consumption, anticoagulant therapy and potentially low cholesterol levels may also play a role. For SAH, smoking appears to be a particularly strong risk factor (Longstreth et al., 1992).

The Treatment Of Identity Diffusion

Particular tactics are geared to deal with the manifestation of extreme aggression in the hours, the management of affect storms, psychopathic transferences, paranoid micro-psychotic episodes, chronic sado-masochistic acting out, and the threat to the treatment by drug or alcohol abuse, eating disorders, and other psychopathologies frequently complicating severe personality disorders. Treatment tactics also involve the application of general psychoanalytic techniques as mentioned before, such as the dynamic, economic, and structural considerations regarding when, how, and what to focus upon and in what order to intervene interpretively in each session. The severity of the fragmentation of the

Risk Factors and Neurocognition

Numerous lifestyle factors that promote or reduce risk for chronic disease have known a impact on cognitive function and its decline. Various health-compromising behaviors exert a negative influence on cognitive function, whereas health-enhancing behaviors are associated with higher levels of performance or potential improvement with intervention. Lifestyle factors can influence cognitive performance by impacting the brain directly or by promoting or reducing the development of chronic diseases that in turn affect the brain. Examples of health-compromising behaviors that are associated with lower levels of cognitive function include smoking (Swan and Lessov-Schlaggar, 2007), heavy alcohol consumption (Oscar-Berman and Marinkovic, 2007), dietary insufficiencies (Gillette et al, 2007), and physical inactivity (Colcombe et al, 2004). Health-enhancing behaviors such as greater intake of antioxidants including omega-3 fatty acids, and vitamins C and E have been associated with higher...

Tuberculosis in the homeless

The reasons for the high incidence of tuberculosis in the homeless and their epidemiological effect in causing new cases are multiple. In spite of a high rate of completion of chemotherapy overall in San Francisco, the highest rates of loss were among the homeless. At least some of these cases continue to be infectious. Many of the persons in this environment are vulnerable to tuberculous infection because of HIV infection or other factors that are more difficult to quantify, such as drug abuse, alcoholism, poor nutrition or generally poor health (Zolopa et al 1994).

Social History And Habits

Social history and habits can also play an important role in pain management therapy. Smoking and alcohol use can complicate acute pain management. Patients who use alcohol on a regular basis can experience various degrees of withdrawal symptoms if it is discontinued abruptly. This is especially important in postsurgical patients. Alcohol withdrawal symptoms can occur 24 to 48 hours after abrupt discontinuation. Alcohol withdrawal can cause anxiety and agitation, which can make the patient far less able to cope with pain. Patients who take several alcoholic drinks daily should be evaluated on hospital admission to receive benzodiaz-epine for withdrawal prevention.

Health Maintenance And Disease Prevention

As noted previously in this chapter, the occurrence and severity of many kinds of diseases are associated with the habits and lifestyle of the person. Lifestyle is, of course, not the only causative factor in promoting disease, but it is an important one and one about which the individual himself can do something. In young adulthood, the ability of the body to ward off disease and to cope with the effects of accidents and stress is at a maximum, but as one grows older, the body's ability to deal with these problems declines. Unfortunately, the health and energy of young adults may obscure their perception of the negative consequences of a poor diet, smoking, alcohol abuse, and other insults to the body that will have carryover effects on their health in middle-and late life. smoking and consumption of alcoholic beverages. But despite the efforts of schools, the government, and other organizational spokespersons to convince people to get a good night's rest, eat breakfast, stop...

Positive Well Being and Physical Health

Period, 3523 had newly diagnosed cardiovascular disease, and there were 1860 fatalities. Low enjoyment of life was associated with increased risk of cardiovascular disease incidence (hazard ratio 1.23, C.I. 1.05-1.44) and mortality (1.61, C.I. 1.32-1.96) in men, after adjustment for age, occupation, BMI, smoking, physical activity, alcohol consumption, diabetes, hypertension, and participation in health screening. Interestingly, effects were maintained when the deaths within the first 6 years were excluded, arguing against the possibility that some participants were already sick with the early stages of cardiovascular disease (and therefore unhappy) at the start of the study. It is not clear why there were no significant associations among women, but their low disease rates may have been responsible.

Psychological Well Being and Health Behaviors

Studies of the relationship between positive well-being and healthy behavior choices have generated rather variable results. Although positive affect and more enduring traits such as life satisfaction have been associated with greater physical activity, not smoking and moderate alcohol consumption in some studies (Dear et al, 2002 Patterson et al, 2004 Schnohr et al, 2005), other investigations have generated null or even reverse results (Diener and Seligman, 2002 Graham et al, 2004 Murphy et al, 2005). Rather less is known about the associations between well-being and other health behaviors such as dietary choice. We carried out an analysis of the relationship between life satisfaction and seven health behaviors using data on more than 17,000 young adults in 21 countries (Grant et al, 2009). Greater life satisfaction was consistently associated with a reduced likelihood of smoking and with an increased rate of regular exercise in all the regions of the world that were tested,...

Neurological side effects Peripheral polyneuropathy

Peripheral polyneuropathy is mainly caused by the NRTIs, zalcitabine, didanosine and stavudine. It usually presents with a distal symmetrical distribution and senso-rimotor paralysis. Patients complain of paresthesia and pain in their hands and feet, and often, with zalcitabine, about perioral dysesthesia. The symptoms often begin gradually after several months of therapy. HIV infection itself can lead to peripheral polyneuropathy, but the drug-induced form becomes apparent much earlier and may develop within a shorter period of time. Patients must be informed that they should consult their treating physician as soon as possible if the typical complaints develop. Additional risk factors for polyneuropathy, such as vitamin B12 deficiency, alcohol abuse, diabetes mellitus, malnutrition, or treatment with other neurotoxic drugs, e.g. INH, should be addressed in the appropriate manner. Symptoms frequently improve within the first two months following discontinuation of the drugs...

Increased bleeding episodes

The median time to onset of an ICH event was 525 days on Tipranavir r. Many of the patients had other risk factors for intracranial hemorrhage such as CNS lesions, head trauma, recent neurosurgery, coagulaopathy, hypertension or alcohol abuse, or were receiving anticoagulant or antiplatelet agents.

O Troubleshooting

Together to try to identify which inclusion was present. The student preliminarily identified the inclusions as Howell-Jolly bodies, which are single inclusion, DNA in origin, and usually located in the periphery of the red cell. Basophilic stippling was another possibility, but stippling is RNA in origin and seen throughout the red cells the new employee noted that the inclusion was located toward the periphery of the cell. The next possibility was Pappenheimer bodies, small inclusions that look like grape clusters. Pappenheimer bodies are usually iron deposits either in the form of ferritin or hemosiderin. If they are suspected, an iron stain (Prussian blue) will confirm the presence of iron. A Prussian blue stain was performed, and the inclusions were confirmed to be siderocytes, iron-containing inclusions. These inclusions can be found in hemochromatosis, alcoholism, hemolytic anemia, and post splenectomy.

Mechanisms Linking Social Networks to Health Outcomes

Berkman and Glass (2000) have gone further to identify a set of four distinct processes and mechanisms by which social networks exert their main effects on health outcomes. They are (a) social influence over health-related behaviors, (b) social engagement, (c) exchange of social support, and (d) access to material resources. Social influence refers to the notion that our behaviors are influenced and regulated by others - an idea that harks back to Durkheim (1897). Socially more well-connected individuals tend to exhibit healthier profiles of lifestyle behaviors compared to socially isolated individuals, e.g., less smoking, better quality diet, more physical activity (Berkman and Syme, 1979 Eng et al, 2002 Kawachi et al, 1996). Social influence is particularly salient in marriage, which is for many people the most intimate of social ties. Longitudinal studies of marital transitions demonstrate the influence of marriage on health behaviors within spousal dyads. For example, when men...

Drug Dependency Assessment

Embarrassed to tell the clinician the truth. Too often, the clinician finds out about the patient's alcohol usage only after the patient starts to experience withdrawal. By then, more aggressive therapeutic and medical interventions may be required, which could easily have been prevented with appropriate medications. At the earlier stages of withdrawal, the patient may only complain of spasms or unrelieved pain in addition to agitation and restlessness. Frequently, the clinicians attribute these symptoms to pain and give more opioids without success. However, appropriate assessment of and judicious use of benzodiazepines by patients with alcohol withdrawal can quickly bring the patient's pain and anxiety under control. The correct assessment will require clinician persistence in pursuing the clinical clues and the assistance of the patient's family members.

Prioritization of Treatment Strategies

Behavioural couple therapy (BCT) is as effective as individual CBT not only with alcohol abuse but also with depression and anxiety disorders (Emmelkamp & Vedel, 2002). Because of Mick's early retirement and the consequences this was going to have on their relationship, and taking into account their overall low marital satisfaction, we decided to offer Dianne and her husband BCT, focusing on the drinking problem as well as their relationship. If still needed, the spouse-aided therapy for alcohol abuse could be supplemented by spouse-aided therapy for depression or anxiety. Because Dianne had already started using Acamprostate, we agreed that she would continue using the anti-craving agent during the course of our treatment.

Relationships of Norms to Health Behaviors

Correlational research supports roles for descriptive and injunctive norms in the longitudinal prediction of both health-protective and health-risk behaviors. Etcheverry and Agnew (2008) documented relationships of both friends' use and approval of cigarettes with the number of cigarettes smoked over time. Similarly, in their meta-analysis, Sheeran et al (1999) observed relationships of both norms to condom use. However, descriptive norms exhibited a significantly larger relationship with the outcome than did injunctive norms. Research has also found only descriptive norms to be predictive of alcohol consumption and needle sharing among injection drug users (Carey et al, 2006 Davey-Rothwell et al, 2009). Additional research supports only a role for injunctive norms in the prediction of alcohol use (Larimer et al, 2004). Accordingly, it is unclear whether either category of norms consistently weighs more heavily than the other in decisions to perform health-protective or health-risk...

The Extent of Misperceptions

Social norms theory originated when Perkins and Berkowitz (1986) noted that undergraduate students were largely inaccurate in their perceptions of their peers' attitudes toward alcohol use. Students by and large reported that their own attitudes concerning heavy alcohol use were conservative, yet they believed that their classmates approved of and held liberal attitudes toward heavy alcohol use. Thus, although the actual injunctive norm favored controlled, moderate levels of drinking, it was perceived that most students were comfortable with heavy drinking. Such misperceptions have been repeatedly documented with respect to alcohol use. Perkins et al (2005) examined data from 76,145 students, representing 130 colleges nationwide, and found that, regardless of the magnitude of the actual drinking norms, students consistently overestimated the prevalence and approval of alcohol use on their campus. In a synthesis of the literature, Borsari and Carey (2003) found that undergraduates...

Sources of Normative Misperceptions

According to the fundamental attribution error, others' behaviors are typically inferred to reflect personal disposition, rather than situational forces (Ross, 1977), leading observers to view heavy alcohol use as indicative of the drinker's permissive attitude towards drinking. Simultaneously privately disapproving of heavy alcohol use, an individual's own dissent could serve as a basis for inferring the true attitudes of others. However, given pluralistic ignorance, the belief that one is alone in disagreeing with the perceived norms, individuals instead infer that their beliefs are highly discrepant from those of the majority (Miller and McFarland, 1987). As might be expected, individuals who engage in heavy alcohol use often believe that most others behave similarly, as the false consensus effect, the tendency to believe that others think and act as one does, biases perceptions of reality (Ross et al, 1977). Conversely, reliance on the availability heuristic can lead moderate...

Consequences of Misperceptions for Behaviors

Students' engagement in heavy drinking over 4 years of college. Perceptions of peer alcohol use and peer support for heavy drinking in years 1, 2, and 3 predicted heavy drinking in years 2, 3, and 4, respectively. Carey et al (2006) examined the influence of discrepancies between the perceived descriptive norm and personal drinking behavior on subsequent drinking behavior. Consistent with the social norms perspective, the degree to which individuals were discrepant from the descriptive norm positively predicted increases in drinking 30 days later.

Applications of Social Norms Theory to Behavior Change

Though some groups demonstrated significant reductions in alcohol consumption outcomes, others indicated more modest results. We will return to potential reasons for null findings in norms-based interventions. Indicated interventions, those targeting individuals at high risk for engaging in risky behaviors (Mrazek and Haggerty, 1994), have proven effective as well. Marlatt and colleagues (1998) conducted brief individualized interventions addressing norms and personal alcohol use with freshmen who reported previous high risk drinking behaviors. At the 2-year follow-up, students who had received the brief intervention drank less frequently and consumed fewer drinks per sitting than a control group of high risk drinkers. Feedback regarding the magnitude of individual drinking relative to that of peers has also been delivered in computerized interventions, successfully reducing alcohol consumption (Neighbors et al, 2004). Similarly, personalized normative feedback mailed to...

Unsuccessful Social Norms Interventions Problems and Solutions

Compared 37 colleges that had implemented social norms campaigns to reduce alcohol use with 61 colleges that had not. While significant decreases were not observed on any measure of alcohol consumption among schools with social norms campaigns, there appeared to be an increase in alcohol consumption on some outcomes. Similar increases were not observed among control campuses. Social norms interventions often fail for one of two reasons - either the intervention was unsuccessful in changing perceptions of the norm or misperceptions changed but did not result in decreases in risky behaviors.

Additional Applications of Norms to Behavior Change

This manipulation successfully increased selection of healthy foods among message recipients and was particularly effective among high self-monitors, individuals who are highly responsive to situational demands. Similar results have been obtained in motivating healthy behaviors among undergraduates by labeling heavy alcohol consumption and eating junk food as common among graduate students (Berger and Rand, 2008).

Management of Depressed Mood

Inactivity being one of Dianne's most salient high-risk situations, we introduced activity training as an intervention to tackle negative mood as well as her drinking problem. Activation training is a fairly common behavioural technique in treating depression, derived from Lewinson's theory of depression. We encouraged Mick to help his wife in organizing her week combining basic daily activities (like getting dressed in the morning), taking care of neglected activities (such as cleaning up the bedroom) and increasing the amount of pleasant activities (listening to music, going out for a cup of coffee with a friend). Given Dianne's social anxiety, a gradual approach was used in having her engage in social situations.

Mesolimbic Dopamine System

Twins separated at birth and reared in different environments, and other studies involving the use of rats, have implicated the gene that codes for one subtype of dopamine receptor (designated D2) in alcoholism. Other addictive drugs, including cocaine, morphine, and amphetamines, are also known to activate dopaminergic pathways.

Ethical Issues in the Quality of Care

Because of the role that behavior plays in the occurrence of many of today's health problems, it has been suggested that many of these so-called health problems be demedicalized (B. Jennings, 1986). For example, illicit drug use, alcoholism, domestic violence, motor-vehicle accidents, and homicide are ills arising from and impacting upon the whole of society and not just the health care system. Demedicalization is intended to foster a multifaceted and integrated strategy for solving the given problem by utilizing and incorporating other rel

The Significance of Race and Ethnicity for Health

Health disparities exist in Australia as well. For example, the infant mortality rate for aborigines persists at greater than two times the Australian national average (Australian Bureau of Statistics, 2007). Additionally, life expectancy is nearly 20 years shorter for aboriginal people than the general population. This largely reflects the higher prevalence rates of heart disease, stroke, diabetes, alcohol consumption, and smoking among members of this group (Australian Bureau of Statistics, 2008 2007).

Discrimination Racism and Stress

Discrimination can affect health in many ways. It can result in reduced access to necessary goods and services, lead to the internalization of negative stereotypes, increase stress, and trigger behavioral responses such as substance use, excessive eating, and failure to adhere to medical regimens that can have adverse consequences for health. For example, findings from a national study in South Africa suggested that perceived chronic discrimination was positively associated with psychological distress (Williams et al, 2008). In the USA, results from several studies showed that racial discrimination was associated with cardiovascular and physiological reactivity among blacks in laboratory settings, worse physical and mental health, higher risk of low birth weight and preterm birth, and engagement in negative health behaviors such as smoking, alcohol consumption, and illicit drug use (Paradies, 2006 Williams et al, 2003). Moreover, studies from the USA, South Africa, Australia, and New...

Nonpsychotic Disorders

The highest frequency of occurrence among nonpsychotic mental disorders is found in substance abuse and alcoholism, which affect over 16 of the general U.S. population (Regier & Burke, 1989). Although alcoholism is at its peak in middle age, many older adults turn to alcohol as a means of coping with grief, loneliness, and pain. Alcoholism in early and middle adulthood occurs more often in men than in women, but, because of loneliness and depression, many women also start drinking in later life (LaRue et al., 1985). Older alcoholics are more likely to manifest impairments in memory and thinking. Because alcohol is rich in carbohydrates but low in proteins and vitamins, long-term users can develop cirrhosis of the liver due to protein deficiency or Korsakoff's syndrome due to vitamin B deficiency. The symptoms of Korsakoff's syndrome, a chronic brain disorder occurring most often in chronic alcoholics in their fifties and sixties, include disorientation, impulsiveness, memory loss,...

Aged Rodents for Biogerontology Research

Human aging is the result of a complex interaction between biological changes and environmental social influences. Healthcare throughout life, diet, and habits such as smoking, alcohol consumption and physical activity can all impact the rate of biological aging and complicate the study of the biology of aging in human populations. The rodent provides a venue for modeling the biological changes with age and investigating the genetic and physiological basis of aging and age-related diseases while controlling intrinsic and extrinsic influences. The genetic background, diet, environment, and health status of the rodent can be strictly controlled. Rodents are similar to humans in much of their physiology, cellular function, and to a lesser degree, even their anatomy. The musculoskeletal system, immune and endocrine systems, and gastrointestinal tract are very similar in both function and architecture between rodents and humans. Cardiac function has been modeled in rodents, as have...

Partnership and Adult Lifestyle

If the delinquent behaviour persists into adulthood, this may indicate an antisocial personality disorder or the more narrowly defined psychopathy (Hare, 1995, 2001). In these cases, deviant behaviour is very hard to modify (Losel, 1998). Such chronic delinquents often have difficulties in forming stable intimate relations or they chose partners that have similar problems (Quinton et al., 1993). Although most criminal careers fade out after the age of 40, other difficulties such as alcoholism, chronic unemployment, psychiatric problems and violence in the family often continue (Farrington, 1989). Such lifestyles, and the inheritance of genetic information create, in turn, developmental risks for the next generation. But, again, this is not necessarily a closed cycle and depends on interactions with protective factors and mechanisms.

Diffusion Magnetic Resonance Imaging DTI

Modest discrepancies in these studies may in part reflect differences in design and or the effects of possible confounds. While differences in technical design are sometimes difficult to assess, revealing potential confounds amongst these various studies has proven to be somewhat easier. The largest confound has been elucidated by the research of Pfefferbaum and Sullivan, who have shown the importance of controlling for patient comorbid neurologic injury risks such as alcohol consumption. For example, in their recent study (2007), they assessed four patients groups alcoholism alone (n 87), HIV infection alone (n 42), alcoholism and HIV infection comorbidity (n 52), and non-affected controls (n 88) matched for lifetime alcohol consumption histories and CD4+ counts and viral loads. Results showed that, compared to controls, each group had lower FA and higher MD in the genu and splenium, but the effects were only significant in the two groups with alcoholism (with the genu more affected...

Summary and Future Research

Despite the advances in MRI and the many important findings in HIV-infected patients to date, improvements can be made in several key areas. One significant improvement in future research studies might be in participant selection. Generally, HIV-infected patients present with additional neurological risks that might be better controlled through patient selection and or the addition of supplementary control groups with different conditions. As already illustrated, Pfefferbaum Sullivan have demonstrated the significant contribution of alcohol abuse among commonly presenting HIV-infected populations. Much has also been written about other subpopulations within HIV-infected cohorts such as drug abuse (71, 121, 122), hepatitis C (HCV) coinfection (75, 123, 124), etc. The use of more controlled research designs will not only broaden our understanding of the neurological effects of these additional factors, but will improve our understanding of the specific mechanisms of HIV-associated CNS...

Balancing The Ideal And The Practical Normative Goals For Mental Health And Aging

These issues, however, do not exhaust the ethical problems at the intersection of mental health and aging. Both prevention and intervention require thinking about underlying or foundational moral demands that we should make on any mental health policies or services. They also raise questions about ''worthiness.'' Can people be held blameless if their illness has its roots in chronic alcoholism or other socially disvalued activities Who should decide what services are offered to whom

Life Course Epidemiology

A life course approach to epidemiology is concerned with the effects on health and health-related outcomes of biological (including genetic), environmental, and social exposures during gestation, childhood, adolescence, young adulthood, and across generations (Kuh et al, 2003). It specifically investigates how risk and protective factors across life act independently, cumulatively, and interactively. Much of the interest in life course epidemiology has centered on chronic diseases (Kuh and Ben-Shlomo, 2004a), such as coronary heart disease, diabetes, and cancer, but its concepts can also be used to understand health behaviors (Schooling and Kuh, 2002). The life course approach to health behaviors can address a range of questions that are highly pertinent to the development of health policy. Does childhood socioeconomic environment influence the consumption of excessive alcohol or binge drinking and is this modified by education and adult socioeconomic position Could the link between...

The Construct Of Psychopathy

Delinquency, consistent sexual deviation, hedonism, and clinical alcoholism, and noted that the typical psychopath . . . is not likely to commit major crimes that result in long prison terms (1982, p. 14). Similarly, Gough suggested that psychopaths would contribute more than their fair share to criminal behavior, but stressed that psychopathy was not explicitly dependent on illegal or asocial behavior.

Estrogen Deprivation Increases Risk for Depression and Medical Illness

American Menopause Society, 2006), it is of interest here that the WHI was also the first large-scale controlled trial to demonstrate a significant reduction in hip fracture of about 35 associated with ERT and HRT use (Anderson et al, 2004 Cauley et al, 2003). While the controversy currently surrounding the use of ERT or HRT in postmenopausal women has limited its use in the prevention of osteoporosis, that estrogen can prevent bone loss in postmenopausal women at doses lower than those required to stimulate classic target tissues such as breast and uterus (Prestwood et al, 2003), suggests a more favorable cost benefit ratio for estrogen in the treatment of osteoporosis. Controlled trials will be needed in order to confirm this. It should also be noted that there are a number of other available FDA approved pharmacotherapy options that have also proven to be efficacious in the treatment of osteoporosis, these include bispho-sphonates, calcitonin, and parathyroid hormone medications...

Is the Pattern of HAND Changing with Aging

Lastly, it has been shown that psychiatric disorders have a greater prevalence in older HIV-infected individuals as compared to younger HIV-infected individuals. This is the case not only for depressive symptoms, but also alcohol abuse and dependence as well as drug abuse and dependence. While depressive disorders have been demonstrated to be independent from HAND (28, 103), this was shown in relatively young individuals and needs to be fully explored in older individuals. Contemporary nonacute drug use in HIV-infection is known to worsen the overall cognitive deficits (104), but the chronic effects of such drugs are less clear (105). It has been shown that lower socio-economic status in HIV+ drug users had more influence on neuropsychological performance than the drug use status per se (106).

Social Function in Old

Aging is generally associated with dramatic changes in social roles and personal relationships. Around the age of 65 most individuals retire. Irrespective of whether retirement is encountered as a welcome or an unpleasant life event, it involves two developmental challenges adjustment to the loss of the work role and the social ties of work and the development of a satisfactory post-retirement lifestyle (van Solinge and Henkens, 2008). Besides possible adjustment problems this may bring about, the change from a working to a retired life evidently can be associated with large behavioral changes that influence social and physical activities, food intake, and alcohol consumption.

Lifestyle Behaviors in Old

Aging has generally rather profound effects on lifestyle behaviors as well, either due to changes in daytime activities (e.g., after retirement or widowhood) or as a result of the considerable increase in disabilities and chronic diseases associated with aging. Specifically, the degree of physical activity may decrease due to physical decline, acquired chronic conditions, and accompanying pain. But other lifestyle behaviors might also be affected. Smoking is an important accelerator of the aging process. In general, the percentage of persons smoking decreases with increasing age, but this may in large part be due to the selective survival of non-smokers, or due to the fact that certain older persons stop smoking because of health reasons. It is important to note, however, that those persons who smoke most probably have been smoking a large part of their lives. This accumulating effect of lifetime smoking might therefore be specifically detrimental in older persons. As with smoking,...

Mortality and Morbidity

Various other chapters in this book report on evidence that social, psychological, and lifestyle factors impact on overall health outcomes. Also, meta-analyses and systematic reviews suggest that lack of social support (Lett et al, 2005), depressive symptoms (Nicholson et al, 2006), and unhealthy lifestyle behaviors such as lack of physical exercise (Oguma et al, 2002) are associated with increased risk of developing cardiovascular disease and all-cause mortality. Although these reviews do not explicitly distinguish between studies using middle-aged and older populations, it is good to realize that in fact the majority of meta-analyzed studies examining the impact of behavioral factors on general health outcomes have been conducted among older persons, simply because morbidity and mortality most commonly occur in the oldest age groups. Therefore, there is no doubt that these behavioral factors continue to impact on general health outcomes such as mortality and (cardiovascular)...

Aging Related Outcome Cognitive Impairment

There is quite extensive evidence that behavioral factors can either progress or inhibit cognitive decline. Lifestyle behaviors, for instance, have been linked with cognitive decline. Certain nutritional indicators such as vitamin Bi2 and folate deficiency, but also an unfavorable cholesterol profile, have been associated with poorer cognition in old age (Solomon et al, 2007 Tangney et al, 2009). Smoking and excess alcohol intake have also been shown to contribute to cognitive decline and avoiding these activities may promote cognitive vitality in aging (Peters et al, 2008a, b). On the other hand, moderate alcohol consumption has been associated with better cognition (Bond et al, 2003 Ngandu et al, 2007). Finally, there is evidence from both animal and human studies to suggest that lifelong learning, mental and physical exercise, and continuing social engagement are important factors in promoting cognitive vitality in aging (Fillit et al, 2002).

Clinical Manifestations

The most common sites affected are the abdomen, femoral shaft, knee, and lower back. The etiology remains unclear. There appears to be an inciting factor in many cases. Inciting factors may include emotional stress, physical exertion, and alcohol consumption. Pain probably results from microinfarction of the end organ, for example, medullary infarction resulting in bone pain. About 1 of sickle cell patients have more than six episodes per year (12).

Treatment of Hypertension

The first form of treatment that is usually attempted is modification of lifestyle. This modification includes cessation of smoking, moderation of alcohol intake, and weight reduction, if applicable. It can also include programmed exercise and a reduction in sodium intake. People with essential hypertension may have a potassium deficiency, and there is evidence that eating food that is rich in potassium may help to lower blood pressure. There is also evidence that supplementing the diet with Ca2+ may be of benefit, but this is more controversial.

Conceptions of Fertility

A landmark study by Ford et al. (2000) explored the effect of paternal age on the likelihood of delayed conception. With a study population of 8515 planned pregnancies, the study found that older men were significantly less likely to impregnate their partners in less than six or less than 12 months, compared to their younger counterparts. After adjusting for various confounding factors such as age of the female partner, BMI, smoking, passive smoke exposure, education, duration of cohabitation, duration of oral contraceptive use, and paternal alcohol consumption, paternal age still remained highly significantly associated with conception within six or 12 months. If paternal age was treated as a continuous variable, there was a statistically significant linear relationship the odds ratio for conception within six months decreased by 2 per year of age, and for conception within 12 months decreased by 3 per year of age. After comparing their study with the existent literature, Ford et al....

The Hypothalamic PituitaryGonadal Axis

Severe chronic stress and HPA axis activation results in suppression of the hypothalamic-pituitary-gonadal axis at all levels (hypothalamus, pituitary, gonads) and a decrease in reproductive activity in general. In women, stress-induced secondary hypothalamic amenorrhea due to glucocorticoid hypersecretion has been observed in melancholic depression, chronic alcoholism, and eating disorders (Chrousos and Gold, 1998 Kyrou et al, 2006). In men, severe stress in real life, i.e., exposure to war, to an earthquake or to a critical life event may lead to impaired sperm quality (Abu-Musa et al, 2008 Fukuda et al, 1996 Gollenberg et al, 2010). Interestingly, a psychological profile of being an active, competitive person may coincide with a low sperm count, possibly through activity-induced activation of the SNS and a deficiency of testicular blood flow. Behavioral therapy focusing on relaxation strategies appear to increase sperm counts and reproductive success in these men (Hellhammer and...

Ineffective Treatment Modalities

The traditional model of treatment in the alcohol problems field is group therapy. It was the principal type of intervention in the residential alcoholism treatment units that dominated the response to alcohol problems in the UK and in other countries from the pioneering work of Dr Max Glatt in the 1950s to the 1980s (Ettore, 1984, 1988). The conduct of group therapy in this tradition was heavily influenced by the teachings of AA and group therapy of this kind is still widely practised today. Unfortunately, there is no evidence that group therapy for alcohol problems is effective. This is shown by the low negative CES for 'group process psychotherapy' in Table 15.1, based on three studies. The involvement of groups of people in the treatment process may be an important principle but there is little justification without further research for continued use of group therapy in the traditional way it has been used in the alcohol field. Alcoholics Anonymous and Twelve-step Facilitation The...

Effective Treatment Modalities

In this section, we shall consider some of the modalities that can be considered effective, as shown by high CESs in the Mesa Grande. Again, the idea is not to describe every single effective treatment for alcohol problems but merely to focus on a few general approaches that are supported by research evidence and can easily be implemented in practice. The highest CES in Table 15.1 is for brief interventions however, there are a number of important considerations to bear in mind here. First, the category of brief interventions contains two different kinds of activity very brief interventions given by generalist workers (for example, general medical practitioners) in community settings to excessive drinkers not complaining of an alcohol-related problem and longer brief interventions, better called 'brief treatment', given by alcohol or addiction workers in specialist treatment centres to those who do complain, or have been persuaded to complain, of an alcohol-related problem (Heather,...

Intensity Setting And Costeffectiveness Of Treatment

With the advent of brief interventions, treatment for alcohol problems has become more variable in length (duration) and intensity (amount of therapist contact). There is little doubt that, for heavy drinkers not seeking treatment and identified by screening in generalist settings, brief interventions of one or two sessions are all that is necessary in most cases for those in the treatment-seeking population with more serious problems the optimal intensity of treatment is unknown. Project MATCH (1997a) found that four sessions of MET were generally as effective as eight sessions of CBT or TSF although, as we have seen, certain types of client benefited more from the more intensive treatments. Nevertheless, the Project MATCH findings suggest that, on the whole, less intensive treatment by MET is more cost-effective than more intensive alternatives (Cisler et al., 1998). Against this, in a reanalysis of the MATCH economic data, Holder et al. (2000) reported that, for certain types of...

Project Title Premenopausal Risk Factors For Coronary Heart Disease In Black White Women

Plasma total and low-density lipoprotein (LDL) cholesterol levels were similar, despite a greater consumption of saturated fat and cholesterol by the black women. Rates of cigarette smoking and alcohol intake were low and similar between the races. Premenopausal black women had a higher mean body mass index, blood pressure, lipoprotein(a), and plasma total homocysteine level, and a greater consumption of saturated fat and cholesterol than white women. These differences in coronary risk factors may place the black women in our study at increased risk for CHD compared with the white women. FUNDING Collaboration with Dr. Gerhard at OHSU PUBLICATIONS Gerhard GT, Sexton G, Malinow MR, Wander RC, Connor SL, Pappu AS, Connor WE. Premenopausal black women have more risk factors for coronary heart disease than white women. Am J Cardiol 82 1040-1045, 1998.

Sexual preferences can be explained by incentive motivation theory without any reference to the concept of homosexuality

A change of food habits may be beneficial both to personal and public health. A change of drinking habits might also be beneficial for personal and public health. The high incidence of cirrhosis in France, for example, could be reduced by convincing the French to drink less wine and more grapefruit juice. On the contrary, a change of the sex of our partner would not have the slightest consequence neither for individual nor for public health. Someone could argue that HIV infection is more common among people having sex with their own sex and therefore the abandonment of that habit would improve public health. This might be true in some cases, but again the improvement would be marginal compared to that potentially caused by improved eating habits. My point here is that there is no particular reason for changing sexual incentives even if that were possible. This statement applies both at the individual and at the societal level. Thus, the question that needs to be asked is not whether...

Nondietary Prostate Cancer Risk Factors

Other factors have been suggested to increase prostate cancer risk but with highly inconsistent results. Alcohol consumption, which is of interest primarily because of its impact on circulatory steroid hormone levels, was recently the subject of a meta-analysis involving 33 epidemiological studies that had assessed alcohol consumption and prostate cancer risk.33 Alcohol consumers overall had a risk of prostate cancer of 1.05 compared to non-drinkers, but risk increased to 1.21 among men consuming at least four drinks per day.

Physical characteristics

The range of head shapes and facial features in this family reflect different feeding behaviors. 1. Choeronycteris mexicana is a nectar-feeding bat with a long snout and bristled tongue 2. Platyrrhinus helleri is a fruit-eating bat with a short snout 3. Chrotopterus auritus is carnivorous, and 4. Lonchorhina aurita is an insect gleaner both have large ears and a nose leaf 5. Diphylla ecaudata is a blood drinker with a short snout and stubby nose leaf. (Illustration by Gillian Harris) The range of head shapes and facial features in this family reflect different feeding behaviors. 1. Choeronycteris mexicana is a nectar-feeding bat with a long snout and bristled tongue 2. Platyrrhinus helleri is a fruit-eating bat with a short snout 3. Chrotopterus auritus is carnivorous, and 4. Lonchorhina aurita is an insect gleaner both have large ears and a nose leaf 5. Diphylla ecaudata is a blood drinker with a short snout and stubby nose leaf. (Illustration by Gillian Harris)

Organ Systems Affected By Low T Levels

Men undergo a gradual loss in bone mass beginning in their 30s. It is estimated that two million men in the United States have osteoporosis and that one in eight men over age 50 will have an osteoporosis-related fracture (NIAMS, 2003). Risk factors for osteoporosis include family history of osteoporosis, smoking, excessive alcohol intake, physical inactivity, poor nutrition, vitamin D deficiency,

Phenotypic variation in human female reproductive development

The most reliable measure of environmental quality in human research is that of socioeconomic status (SES), which predicts multiple health outcomes. Studies, including those using prospective analyses, reveal significant effects of SES during childhood that are statistically independent of those associated with adult SES, on adult mortality (Davey-Smith et al., 1998 Kaplan and Salonen, 1990 Marmot et al., 2001), metabolic (e.g., body mass index, hip waist ratio) and cardiovascular (Barker, 1992 Blane et al., 1996 Bosma et al., 1999 Brunner, 1996 Kaplan and Salonen, 1990 Poulton et al., 2002 Power et al., 2005 Rahkonen et al., 1997). Likewise, there are effects of SES in early life on psychological function and mental health. Childhood SES affects alcohol dependence in adulthood and the effects are not reversed with subsequent upward mobility (Poulton et al., 2002). An extensive, prospective study by Gilman et al. (2003) found a clear effect of childhood SES on depression (Kessler et...

Studies Of Psychological Treatments In Bipolar Disorders

A study by Scott, Garland & Moorhead (2001) examined the effect of 20 sessions of CT in 42 clients with BP. Participants could enter the study during any phase of BP. Clients were initially randomly allocated to the intervention group or to a 'waiting-list' control group who then received CT after a six-month delay. The randomized phase (six months) allowed assessment of the effects of CT plus usual treatment as compared with usual treatment alone. Individuals from both groups who received CT were then monitored for a further 12 months post-CT. At initial assessment, 30 of participants met criteria for an affective episode 11 participants met diagnostic criteria for depressive disorder, three for rapid cycling disorder, two for hypomania, and one for a mixed state. As is typical of this client population, 12 participants also met criteria for drug and or alcohol problems or dependence, two met criteria for other Axis I disorders and about 60 of the sample met criteria for personality...

Environmental adversity and reproductive development

The relation between interuterine growth retardation, resulting in diminished birth weight, and an early onset of sexual maturation may seem somewhat counterintuitive. Note, however, that this relation is only apparent under conditions of adequate postnatal nutrition, and indeed is best reflected in those children that reveal postnatal catch-up growth. Interuterine growth retardation is a reliable consequence of materno-fetal function under conditions of environmental adversity. Indeed, increased activity of the maternal and or fetal hypothalamic-pituitary-adrenal (HPA) axis is considered the proximal cause of interuterine growth retardation (Goland et al., 1993, 1995 Matthews and Meaney, 2005 Meaney et al., in press Seckl, 1998). Thus, poverty is associated with a significantly increased risk for inter-uterine growth retardation (IUGR) and the major predictors of low birth weight, maternal protein deprivation, tobacco and alcohol consumption, and maternal stress anxiety are related to

Cognitive and Psychiatric Disturbances

Earlier literature described euphoria as a feature of MS (120). However, depression is now recognized much more commonly, with 50 or more of patients experiencing this affective disturbance in some form during the course of the illness (121-123). Although this is usually relatively mild, major depression can occur (123). Suicide may be a major cause of mortality, accounting for 15 of adult deaths in one series (124). Recently, Feinstein (125) identified warning signs that include living alone, having a family history of mental illness, and reporting social isolation. Patients with a prior history of major depression, anxiety disorder, or alcohol abuse are also particularly vulnerable. The so-called euphoria is actually the inability to inhibit emotional expression, resulting in inappropriate laughing and crying. This occurs with subcortical forebrain lesions (126). Other instances of apparent euphoria seem to be associated with evidence of significant cognitive decline. Euphoria is...

Issues In Translation Of Personality Scales

The MCMI inventory of 20 clinical scales has a concise 175-item true-false self-report format sufficient to cover a span of nine clinical symptom syndromes (anxiety, somatoform, hypomania, dysthymia, alcohol abuse, drug abuse, psychotic thinking, psychotic depression, psychotic delusion), three pathological personality disorders (schizotypal, borderline,

Diseases Laws And Social Constructs

While the 'presence of an invading organism' is a key feature of many things we term 'diseases', it is by no means the case that all 'diseases' have this 'scientific' feature. 'Addiction' and 'alcoholism' for example are both regularly conceptualised as diseases (signalling that 'treatment' is appropriate) although there is no invading organism and the main 'disease' symptoms consist of an organised, planned and generally well integrated sequence of behaviours directed towards the goal of acquiring the next fix. These arguments have been discussed elsewhere (Davies, 1997a). 'Gambling addiction' is perhaps the most striking example of this type of functional labelling, possessing neither an invading organism nor an external pharmacology (see Davies, 1997a, pp. 71-73, for a critique of the argument that there is an internal pharmacology) and thereby opening the door to the labelling of any other type of doggedly determined behaviour as an 'addiction' (e.g. shopaholism, computer-game...

Physical Psychological And Socioeconomic Sequelae

Apart from the physical injuries sustained by child soldiers, another area of concern for aid agencies and healthcare workers is the psychological health of these children. A recent Belgian study revealed the extent of this problem in a voluntary survey of former child soldiers of Uganda's notorious Lord's Resistance Army. Of the 301 children interviewed, 77 had witnessed at least one killing, 39 had been forced to kill, 39 had abducted other children, 63 had looted and burned civilian homes, and 52 had been seriously beaten. A secondary survey was conducted on a randomly selected subgroup of 75 children, of whom 71 agreed to participate. They completed a questionnaire designed to evaluate the extent of posttraumatic stress disorder (PTSD). A score of greater than 24 on the impact of event scale-revised (IES-R), which is a self-report scale akin to the DSM-IV criteria for PTSD, indicates clinically significant symptoms. The mean IES-R score was 53.5, with 97 of participants falling...

Social Anxiety In Children And Adolescents

Social anxiety is often evident early in life and may be diagnosed in children as young as eight years old (Beidel & Turner, 1998). Furthermore, when the social fears of children continue to be expressed through late adolescence they are more likely to be associated with a poor prognosis for recovery (Davidson et al., 1993 Mannuzza et al., 1995). The clinical presentation of social anxiety in children is similar to that of adults, with comparable somatic symptoms and feared situations. However, because of the limited cognitive development of younger children, they may not report specific negative cognitions (Beidel & Turner, 1998). Social anxiety in children is also associated with significant distress and impairment, including poor school achievement, greater loneliness, and difficulties with social relationships (Albano, Chorpita & Barlow, 1996a). Socially anxious children and adolescents may also suffer from elevated rates of general anxiety, depression, and secondary alcohol abuse...

Gaps In The Evidence Base

Of major concern is the limited number of therapists who can recognize and effectively treat social anxiety disorder. Clinicians are most likely to recognize and diagnose a psychological problem in socially anxious persons who present with a comorbid condition -typically major depressive disorder or alcoholism - and are most likely to treat the comorbid condition before the social anxiety (Ballenger et al., 1998). In addition, studies have reported that, among the anxiety disorders, the most highly utilized psychosocial treatments are dynamic psychotherapy (Goisman, Warshaw & Keller, 1999) and supportive therapy (Rowa et al., 2000). There appears to be an underutilization of efficacious treatments in favour of those that have been less well studied. One promising study demonstrated that general practitioners may be trained successfully to provide brief exposure therapy (eight sessions of 15 to 20 minutes' duration) within a primary-care setting (Blomhoff et al., 2001 Haug et al., 2000...

Frontotemporal lobe dementia FTD

Fronto-temporal dementia is a pleomorphic neuro-degenerative illness which typically begins before the age of 65 years. In a minority of cases, the disease is inherited as an autosomal-dominant trait (Lynch et al., 1994 Wszolek et al., 1992). The disease often begins with personality and behavioral changes including disinhibition manifest by alcoholism, hyper-religiosity, hypersexuality, hyperphagia (elements of the Kluver-Bucy syndrome) and stealing. As the disease progressed in these families, further abnormalities in judgment, language and praxia developed. In addition to these cognitive changes, some patients also developed Parkinsonism and amyotrophy. However, presentations with primary progressive aphasia, Parkinsonism, dystonia and or oculomotor disturbances are not infrequent. Neuropathologically, the illness is typified by fronto-temporal atrophy with severe neuronal loss, spongiform change in the superficial layers

The search for diagnostic criteria

The requirements for being considered hypersexual in Sweden do not seem to be remarkably demanding. For a man, reading a pornographic magazine once a week and masturbating every other day, plus having shown one or more infidelities in a lifetime appears enough. For a woman, masturbating once a week and watching a pornographic movie once every three months, plus having been unfaithful to the partner or ever having engaged in group sex is sufficient. In a statistical sense, all these behaviors are far from average, and therefore acceptable criteria of abnormality for those defining 'normal' as being close to average. The fact that there is some relationship between high impersonal sexual activity and behaviors judged inconvenient by contemporary society, like smoking and drinking alcohol, justifies, according to L ngstrom and Hanson (2006), the use of the label excessive when referring to these activities. They show some modesty, though, when remarking that 'the current study did not...

Project Title Surveillance And Analysis Of The Unc Alumni Heart Study

Summary (investigator's abstract) The UNC Alumni Heart Study continues to examine the impact of hostility on health behaviors and psychological status at midlife to test the prospective associations of hostility with coronary heart disease (CHD) events and other health outcomes. The Specific Aims of the proposed research are 1 To better understand the dynamic interrelationships of psychosocial and behavioral risk factors of the adult life span, we will map the trajectories of hostility, depression, smoking, body mass, exercise patterns, and alcohol consumption using multiple assessments from age 19 to age 60. It is predicted that a significant proportion of the change in risk behavior will be due to trajectories of hostility and depression, operating singly and in combination over time. 2 To test the prospective associations of hostility, depression, and other psychosocial variables (e.g., social support and job strain) with coronary events and mortality observed while the cohort is...

The Social And Applied Context

As a final example of a more applied use of ERP research, investigators have been examining the effects of alcohol on P300 and other ERP components (such as the MMN and the O-wave) in the hope of (a) identifying possible biological markers of high risk to develop alcoholism (e.g., Polich & Bloom, 1988 Jaaskelainen, et al., 1996 Eckardt et al., 1996 for reviews, see Jaaskelainen, Naatanen, & Sillanaukee, 1996 Porjesz & Begleiter, 1996) or (b) identifying the acute effects of alcohol on cognitive and social processes, including person perception (Bartholow et al., 2003) and racial stereotypes (Bartholow et al., 2006).

Forensic and Chemical Warfare Toxicology

NMR is not widely used in forensic toxicology, probably due to the perceived poor sensitivity and the lack of routine access to high-field ( 500 MHz) NMR instrumentation. Some interesting historical examples using low-field magnets demonstrate the versatility of NMR for identifying biomarkers of poisoning. Cartigny and colleagues 36 reported on a 4-month-old girl who presented with agitation, fever, dehydration, and metabolic acidosis. Metabolites including o-hydroxyhippuric acid, 2,5-dihy-droxyhippuric acid, and 2-hydroxybenzoic acid (salicylic acid) were observed in XH NMR spectra of freeze-dried urine, which indicated that she had been poisoned with aspirin. The pattern of unusual metabolites can provide a biomarker of aspirin poisoning. This result was remarkable in that an 80-MHz system was employed. NMR has also been used to monitor progressive liver failure following paracetamol-related overdose (10 g) 37 . In addition, the second-ever known instance of acute intentional...

Self Psychologically Influenced Framework For Personality Disorders

I also include the antisocial personality disorder in this category of self disorders where the principal concern is that of preserving a thriving self through idealization or twinship, although I regard this form of psychopathology as different in some important respects from histrionic and dependent personality disorders. Its prominent links with familial alcoholism and or affective disorder undoubtedly represent important etiological factors. Moreover, psychophysiologic hyporeactivity impairs emotional learning that may also be under genetic influence. These influences contribute to the disposition to criminality, failure to learn or profit from experience, impaired empathy, and the characteristic deficiency in interpersonal concern, in which antisocial behavior in its various forms is the final common pathway of a biologically based disturbance. Antisocial personality disorder represents, therefore, a complex disorder that probably cannot be accounted for by any psychoanalytic...

Risk factors diseases and comorbidities

Important ED risk factors coexist frequently in HIV patients, including excessive alcohol consumption, smoking and other recreational drug use metabolic disorders (hyperlipidemia, diabetes mellitus) and cardiovascular disease, with hypertension being of particular importance. Pathophysiologically, most cases of ED are caused by neuronal (polyneuropathy) and vascular (micro- and macroangiopathy) changes however, ED can also be an early sign of a metabolic syndrome.

Introduction To Mood Disorders And Limitations Of Current Treatments

Bipolar disorder and unipolar depression are classified as mood disorders. They are common, severe, and chronic illnesses. Depression is typified by a depressed mood, anhedonia (inability to experience pleasure), feelings of worthlessness or excessive guilt, impaired sleep (either insomnia or hyper-somnia), cognitive and concentration deficits, psychomotor changes, recurrent thoughts of death or suicide, and a variety of neurovegetative symptoms. In bipolar disorder, patients typically alternate (albeit not in a one-to-one manner) between episodes of depression (mostly indistinguishable from unipolar depression) and episodes of mania, which is characterized by a heightened mood, hyperaroused state, racing thoughts, increased speed and volume of speech, quicker thought, brisker physical and mental activity levels, inflated self-esteem, grandiosity, increased energy (with a corresponding decreased need for sleep), irritability, impaired judgment, heightened sexuality, and sometimes...

Proton Magnetic Resonance Spectroscopy

Similar to structural imaging findings, MRS investigators have also examined several potential confounds known to confer additional neurological risks, including alcohol abuse, drug abuse, and aging. In the Pfefferbaum et al. (49) study, the authors compared the metabolite findings of four experimental groups HIV+ plus alcoholism (n 15), HIV+ only (n 9), alcoholism only (n 8), and 23 controls. Importantly, HIV+ groups were matched for CD4 cell counts and alcoholic patients were matched for self-reported lifetime alcohol consumption. Metabolites measured in the parietal-occipital region of the brain demonstrated significant findings for the HIV+ alcoholic group only with nearly a full standard deviation reduction in NAA and Cr regardless of HAART status (49). Though there was no significant alteration of these metabolites for the HIV+ or alcoholic only groups, this may be the result of sampling the parietal-occipital region only rather than areas known to be affected in both excessive...

Visual incentive stimuli

A few rather old studies tried to match men's preferences for certain female body types with personality characteristics. They did not directly address the issue of sexual incentive properties of the body shapes, but the aspects of body shape that were evaluated seem to be those considered sexual incentives at the time and perhaps also at present. These aspects were breast size, buttock size and leg thickness. Furthermore, it was maintained that contemporary society, that is American society in the 1960s, classified men as Breast Men, Buttock Men and Leg Men, according to which part of the female body they gave most importance. In an amusing study, men were asked to make pairwise comparisons of all possible combinations of silhouettes of nude women with varying breast sizes, buttock sizes and leg thickness. The results were subjected to a most complex statistical analysis, which allowed for the identification of five groups of men. The first group is those preferring women with ample...

Pathways Linking Positive Well Being with Health

More favorable health habits and making healthier behavioral choices than less happy people. Numerous lifestyle factors, including smoking, alcohol consumption, regular physical exercise, dietary choice, and sexual risk behavior are potentially associated with positive affect. The fourth possibility is that differential psychobi-ological activation is involved, implicating differences in neuroendocrine, autonomic, immune, and inflammatory responses. Both these pathways are discussed in further detail below.

Review Activities

Fetal alcohol syndrome, produced by excessive alcohol consumption during pregnancy, affects different aspects of embryonic development. Two brain regions known to be particularly damaged in this syndrome are the corpus callosum and the basal nuclei. Speculate on what effects damage to these areas may produce.

Stage Models of Health Behavior

The SCMs considered above assume that the cognitive determinants of health behaviors act in a similar way during initiation (e.g., quitting smoking for the first time) and maintenance of action (e.g., trying to stay quit). In contrast, in stage models psychological determinants may change across such stages of behavior change (see Sutton, 2005, for a review). An important implication of the stages view is that different cognitions may be important determinants at different stages in promoting health behavior. The most widely used stage model is Prochaska and DiClemente's (1984) Transtheoretical Model of change (TTM). Their model has been widely applied to analyze the process of change in alcoholism treatment and smoking cessation. DiClemente et al (1991) identify five stages of change pre-contemplation (not thinking about change), contemplation (aware of the need to change), preparation (intending to change in the near future and taking action in preparation for change), action...

Aging Related Outcome Physical Decline and Disability

Physical inactivity in midlife continues into old age (Ferrucci et al, 1999a Pluijm et al, 2007). This is particularly an important observation, since the level of physical activity is potentially modifiable through exercise regimens. The latter is supported by evidence from exercise intervention studies, which have confirmed that older persons participating in an exercise intervention score better over time on self-reported physical function scales or objective physical assessments than peers in the control arm (Ettinger et al, 1997). Also, smoking and heavy alcohol consumption in old age -which likely reflect high life course exposure -have been consistently associated with increased physical function decline (Ferrucci et al, 1999a Stuck et al, 1999 Wannamethee et al, 2005).

Neurophysiological Factors

Many supporters of a neurological explanation of age-related declines in intelligence view it as the result of small changes in the brain produced by high blood pressure, alcoholism, and other pathological conditions (Rinn, 1988). It is certainly true that intellectual functioning is affected by health status and that people with higher intellectual abilities are healthier and live longer than those with lower abilities. Self-reports of physical and mental health confirm the results of medical diagnoses in this regard (Perlmutter &

Modes of Assessment

Studies examining differences between SAQ formats demonstrate that computer-administered self-interviews (CASI) may increase the reporting of sexual behaviors. Over a 3-month period, participants recalled their sexual behavior (e.g., frequency of unprotected sex) more accurately using the CASI compared with other types of self-report assessments (McAuliffe et al, 2007). College students completing CASI report more alcohol consumption and riskier sexual behaviors than those completing paper-based SAQ (Booth-Kewley et al, 2007). Finally, an increase in gynecological symptoms was reported among STI patients completing a CASI compared with those using a paper-based SAQ (Robinson and West, 1992). Higher self-reports of sensitive behavior among CASI users may be due to an increased a sense of privacy and credibility not provided by paper-and-pencil SAQs (Schroder et al, 2003b).

By Force of Habit

Many behaviors of interest in behavioral medicine are highly repetitive. This holds of course for addictive behaviors, such as smoking and drinking alcohol, but also for many other behaviors that may have health consequences, such as eating, exercising, and hygiene-related behaviors. A number of popular socio-cognitive models in health psychology describe determinants of health behavior, such as the Health Belief Model (Janz and Becker, 1984), Protection Motivation Theory (e.g., Rogers and Mewborn, 1976), and the Theory of Planned Behavior (Ajzen, 1991). However, none of these models include constructs that represent the repetitive nature of behavior, such as an assessment of past behavior. The models implicitly suggest that past behavior influences future behavior through the model components. Yet, when past behavior is taken into the equation, it appears a powerful predictor of later behavior over and above the model variables (e.g., Albarracin et al, 2001).

Context Cuing

Of bodily and mental activities, objects, spaces as well as specific forms of knowledge (including emotions and desires), discourses, and language. For instance, going out may be defined as such a practice. In being socially or culturally defined, practices are routinized phenomena. Individuals are the agents that carry them out. Habits may be part of practices, which thus incorporate the context and cues that trigger habitual responses. The habit of binge drinking or eating junk food may thus be part of the practice of going out. Habits may thus be considered a wider and socially meaningful perspective.

Neurologic Disorders

Although analytical epidemiologic studies on dementia are facing particular logistic challenges (e.g., the need to rely on proxy respondents in case-control studies), a number of risk factors have now been quite consistently established in more recent large-scale prospective cohort studies. Genetic factors undoubtedly play some role, particularly among early onset cases, with the ApoE-fi4 alleles being the best established single markers. The ApoE-fi4 allele is also an established risk factor for cardiovascular disease (CVD). Other risk factors of CVD linked to the occurrence of dementia include diabetes, hypertension, hyperlipedemia, and high levels of plasma homocysteine. As is the case for CVD, moderate alcohol consumption as well as intake of nonsteroidal anti-inflammatory drugs seem to be protective (Borenstein Graves, 2004).

Health Behaviors

There is also considerable evidence that hostility is associated with a broad range of risky health behaviors (Bunde and Suls, 2006). In a prospective study of over 4000 college graduates who had taken the MMPI as freshmen, Siegler and colleagues (1992) found that when followed up 25 years later, those with higher hostility at age 18 had higher lipid ratios, body mass index, smoking rates (and lower quit rates), and alcohol consumption as well as lower exercise rates. In a cross-sectional evaluation of hostility-risk factor associations in the CARDIA study, Scherwitz et al (1992) found high hostility associated with increased waist hip ratio, caloric intake (600 more calories day in high hostiles), smoking rates, marijuana use, and alcohol consumption.

Avascular necrosis

The incidence of asymptomatic avascular necrosis is approximately 0.4 of HIV patients, significantly more frequent than in the general population (Lawson-Ayayin 2005). The postulated association with PIs could not be confirmed (Miller 2002, Loiseau-Peres 2002). Risk factors for avascular necrosis are alcohol abuse, hyper-lipidemia, steroid treatment, hypercoagulability, hemoglobinopathy, trauma, nicotine abuse and chronic pancreatitis. Virological (viral load) or immunological parameters are not associated with a risk of developing avascular necrosis (Miller 2002, Mondy 2003, Lawson-Ayayin 2005).

Aversion Therapy

Aversion therapy includes a variety of specific techniques based on both classical and operant conditioning paradigms. Aversion therapy used to be widely employed in the treatment of alcohol abuse dependence, but is currently more of historical interest. With aversive conditioning in alcohol-dependent subjects a noxious stimulus (UCS) is paired with actual drinking (CS) or with visual or olfactory cues related to drinking, with the aim of establishing a conditioned aversion for drinking. A variety of aversive stimuli have been used, the most popular of which were electric shocks and nausea- or apnea-inducing substances. Covert sensitization is a variant of aversive conditioning wherein images (for example of drinking situations or of deviant sexual stimuli) are paired with imaginal aversive stimuli (for example a scene in which the patient vomits all over himself). It is called 'covert' because neither the undesirable stimulus nor the aversive stimulus is actually presented, except in...


Patients should routinely be questioned and examined for cardiovascular risk factors, such as smoking, hypertension, adiposity, type 2 diabetes, and family history. For an accurate assessment of blood lipid levels, it is recommended to obtain blood after a fasting of at least 8 hours. Total cholesterol and triglycerides together with LDL and HDL cholesterol should be obtained prior to the initiation of, or switch to, a new potent antiretroviral therapy and repeated 3 to 6 months later. Fasting glucose should be assessed with at least a similar frequency. The oral glucose tolerance test (OGTT) is a reliable and accurate instrument for evaluating insulin resistance and glucose intolerance. An OGTT may be indicated in patients with suspected insulin resistance such as those with adipositas (BMI 27 kg m2), a history of gestational diabetes and a fasting glucose level of 110 to 126 mg dl (impaired fasting glucose). The diagnosis of diabetes is based on fasting glucose levels 126 mg dl,...


Many of Dianne's symptoms (such as sleeping difficulties, muscle tension, poor concentration and low self-esteem) could be accounted for by each of the four problem areas discussed above. We decided to focus our attention on Dianne's drinking as a first step. In general - even with severe comorbid conditions - targeting the drinking problem is the treatment of choice. There is no evidence that, if the patient is not able to control his or her alcohol consumption, targeting other pathology cooccurring with alcohol dependence will be effective and should be considered as a first choice for treatment.

Neo Lamarckism

Neo-Darwinism emerged in the early 1880s, shortly after Darwin's death. The movement was led by the Freiburg zoologist August Weismann, who denied that the inheritance of acquired characteristics ever occurred. Fierce debates emerged between strict selectionists and those who maintained that the inheritance of acquired characteristics played the crucial role in progressive evolution. In the United States, the paleontologists Edward Drinker Cope (1840-1897) and Alpheus Hyatt (1838-1902) led a neo-Lamarckian school.24 In France, a major tradition of neo-Lamarckism emerged in the 1880s and persisted throughout most of the twentieth century (see chapter 17).25 Neo-Lamarckism was also strong in Germany, during the late nineteenth and early twentieth centuries Ernst Haeckel himself was one of its chief defenders. Debates over the inheritance of acquired characteristics shaped the growth of evolutionary biology and led to proposals in the 1890s to set up institutions devoted to the study of...


Clinical studies of amnesia (loss of memory) suggest that several different brain regions are involved in memory storage and retrieval. Amnesia has been found to result from damage to the temporal lobe of the cerebral cortex, the hippocampus, the head of the caudate nucleus (in Huntington's disease), or the dorso-medial thalamus (in alcoholics suffering from Korsakoff's syndrome with thiamine deficiency). A number of researchers now believe that there are several different systems of information storage in the brain. One system relates to the simple learning of stimulus-response that even invertebrates can do to some degree. This, together with skill learning and different kinds of conditioning and habits, are retained in people with amnesia.


One of the few modifiable risk factors that have been associated consistently with breast cancer is alcohol consumption. Women who drink on average one alcoholic beverage daily have 10 -30 higher risk of incident breast cancer than nondrinkers.48,49 It has been hypothesized that drinking in early adult life may be particularly deleterious for breast cancer risk 50 studies of the relationship between alcohol and pre-menopausal breast cancer are fewer and less consistent than studies of postmenopausal women.51 However, recent studies suggest that there is no increased risk from alcohol consumption among premenopausal women. A pooled analysis of six prospective studies of mainly postmenopausal women did not find evidence of effect modification by menopausal status,48 and a recent study examining alcohol and breast cancer mortality in a large prospective cohort found no increased risk among premenopausal women.52 Further, a cohort study among women 25-42 years of age found that neither...

Multiproblem Milieu

Problems in the family climate and parenting behaviour interact with more objective and demographic family risks. These are, for example, poverty, lower socio-economic class, early and single motherhood, parental divorce, alcoholism, and criminal record. Taken individually none of these factors explains much variance (Hawkins et al., 1998 Lipsey and Derzon, 1998). However, their accumulation and interaction with other risks constitutes a multi-problem milieu of high risk for delinquency (Rutter, Giller and Hagell, 1998). Such accumulations are found outside the family as well. For example, deprived, disintegrated and violent neighbourhoods represent a delinquency risk (Catalano et al., 1998 Gorman-Smith and Tolan, 1998). Such a milieu contains social models for delinquency, violence, truancy, drug use, and so forth. However, the influence of the wider social context must be seen in interaction with family and individual factors. Wikstrom and Loeber (2000), for example, found that a...

Acute pancreatitis

The classic presentation is a sudden onset of severe epigastric pain, radiating to the back, associated with profuse vomiting. The patient will often be unable to keep still with the pain, in contrast to the immobile patient with peritonitis. A history of previously diagnosed gallstones, or alcohol consumption, is helpful, but not conclusive. Hypotension, tachycardia, tachypnoea, oliguria, and jaundice may be present, especially in severe cases. Biochemical tests are often crucial in the diagnosis, serum amylase measurement being the most widely recognised, with British Society of Gastroen-terology guidelines suggesting a level four times above normal as diagnostic. It is important to remember that a raised amylase by itself is not diagnostic of acute pancreatitis, but has to be taken in context of the clinical picture. Also if the presentation is delayed then the peak level of amylase may be missed and the diagnosis may be more difficult. Serum lipase measurements are less widely...

Biological Factors

Biological and biosocial risks are also involved in persistently delinquent and particularly aggressive adolescents (Raine, 1997 Rowe, 1994). Genetic factors play a significant role in differences in temperament and cognitive functions (Plomin, 1994). Biological dispositions for criminal behaviour can also emerge prenatally through alcohol abuse and smoking during pregnancy, perinatally through birth complications or post-natally through deprivations in emotional care, stimulation, and nutrition during infancy (Hodgins, Kratzer and McNeil, 2002 Moffitt, 1993 Raine, 1993). However, biological risks should not be viewed in too isolated a manner. For example, prenatal and perinatal complications seem to become only significant for specific forms of delinquency when they are accompanied by social risks such as lower-class milieu, parental rejection, or family instability (Brennan, Mednick and Raine, 1997 Hodgins et al., 2002). A deprived relationship with the primary caregiver can impair...


Jaundiced patients are often presented to surgeons with a diagnosis of obstructive, post-hepatic jaundice, already made. It is important though to consider other causes of jaundice in the history and examination, and questions should cover recent foreign travel, alcohol intake, drug history, blood transfusions, and sexually transmitted diseases. Examination may reveal signs of chronic liver disease such as finger clubbing, palmar erythema, spider naevi, and caput medusa.


In general, however, the results of this and other studies (e.g., Berkman & Syme, 1979) support the conclusion that close social ties and higher social status, which are more likely to be found in marriage than outside it, favor greater longevity. This relationship suggests that social interaction, such as is found in marriage, is as important as diet, alcohol consumption, smoking, or exercise in promoting a long life (see House, Robbins, & Metzner, 1982).


For most of the developed world, teenage smoking is associated with lower parental socioeconomic status, though this relationship varies by gender and across culture. In the USA, although girls from minority groups are more likely to be less affluent than their white peers, they are less likely to take up smoking (2006 Johnson and Hoffmann, 2000). The relationship between parental socioeconomic status and alcohol consumption in adolescence is also not clear-cut (Hanson and Chen, 2007 Wiles et al, 2007).


With respect to the maintenance of health behaviors, a number of studies have examined the extent that childhood socioeconomic status has a long-term impact on adult behavior, independent of socioeconomic status in adulthood. For instance, after adjusting for current social class (at age 36), findings from the 1946 British birth cohort indicate that women from manual class in childhood were more likely to be a smoker, remain a smoker, be inactive, and have an unhealthy diet, but had lower alcohol consumption than women from non-manual backgrounds (Schooling and Kuh, 2002). However, findings from other studies are not consistent, possibly due to temporal trends, birth cohort effects, and eco-social differences between countries (Brunner et al, 1999 Leino et al, 1999).


Childhood socioeconomic position greatly influences educational opportunities and other learning experiences (Kuh et al, 2004c), though the size of this effect may vary by culture, country, and location. Education can have an important role in shaping health behaviors, both in conjunction with and outside of the childhood socioeconomic status, and often provides an important setting for the delivery of targeted health messages. Findings from a number of studies indicate that the educational characteristics of students, such as having low aspirations, leaving school at an earlier age, and poor educational performance are associated with the uptake of smoking (McDermott et al, 2009 Tyas and Pederson, 1998), less healthy eating (Neumark-Sztainer et al, 2003 Sweeting et al, 1994), less physical activity, and more alcohol use and binge drinking (Crum et al, 2006, 1998 Sweeting et al, 1994). In contrast, other findings show that in adolescence the adoption of healthy lifestyle occurs prior...

Adult Transitions

There is some evidence that spouses influence each other more with respect to health behaviors (Ellison et al, 1999 Pyke et al, 1997 Wood et al, 1997) than parents influence children or siblings influence each other (Mattocks et al, 2008). For example, in the Family Heart Health study from the National Heart, Lung and Blood Institute, familial associations for behaviors -alcohol consumption, exercise, and smoking -were strongest for spouses and notably weaker for parent-offspring and siblings correlations (Ellison etal, 1999).

Beat The Battle With The Bottle

Beat The Battle With The Bottle

Alcoholism is something that can't be formed in easy terms. Alcoholism as a whole refers to the circumstance whereby there's an obsession in man to keep ingesting beverages with alcohol content which is injurious to health. The circumstance of alcoholism doesn't let the person addicted have any command over ingestion despite being cognizant of the damaging consequences ensuing from it.

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