What are recreational drugs? |

History of Use

The nontechnical term recreational drug identifies the casual use of drugs. The term, which became common in the 1990s, is now frequently employed in the mass media and in popular discourse. The concept of using drugs for “recreational” purposes differentiates such use from the four other established uses and effects: medicinal, spiritual, addictive, and performance-enhancing.

While such distinctions can usefully serve to denote the type of use, they do not neatly classify the types of drugs used, because the same drug can be used for more than one such purpose. For example, most of the legal drugs that are used recreationally, especially nicotine, alcohol, and caffeine, are often also addictive. Also, many of the prescription drugs used for medicinal purposes can also be used recreationally and can be addictive. Likewise, many illegal drugs, such as cocaine and heroin, are used recreationally and are addictive. Drugs such as LSD, mescaline, ecstasy, peyote, and marijuana are used for spiritual and recreational purposes, and the latter is now also commonly used for medicinal reasons.

Several of the drugs now used recreationally have been used throughout the history of civilization. Alcohol was first fermented in west Asia about 8000 bce, marijuana was used in Asia as early as about three thousand years ago, and mushrooms containing the psychedelic chemical psilocybin have been available to humans for thousands of years. Initially, these drugs were used for medicinal and religious purposes, and recreational use emerged as a deviation.

Recreational drug use is endemic throughout all historical eras and geographic regions, but the particular drugs used vary widely across different cultures, places, and times. Alcohol and marijuana have been the two most prevalent across time and culture. Both have been the target of many unsuccessful attempts at prohibition. Among other drugs that have been in widespread recreational use for several centuries are coffee, tobacco, and opiates.

In the United States during the 1950s, two groups of prescription drugs were commonly used beyond their medicinal purposes: barbiturates, which were used as tranquilizers, and amphetamines, which were used as stimulants. Amphetamine came to be known casually as speed and was increasingly used recreationally through the 1960s and later. Also, LSD, which had been synthesized in 1943, was studied for its medicinal and therapeutic uses in the 1950s and early 1960s. Successful outcomes were indicated in the treatment of felons and alcoholics. Some performance-enhancement uses also were studied, mostly for artistic creativity. During the 1960s, the spiritual use of LSD became more common. With this widening pattern of use, LSD also came to be used recreationally, especially among college students, and it was made illegal in 1966.

Psychedelics derived from plants, especially mescaline and psilocybin, also became popular around the mid-1960s. Again, these substances were used first for spiritual purposes, which had been their long-standing function among the indigenous peoples in the United States and Mexico; a wider use by youth included recreational pursuits. Marijuana use also increased dramatically in the 1960s and early 1970s.

During the late 1970s, especially among the disco and punk music subcultures, the use of amyl nitrates (poppers) as inhalants became common. The 1980s saw the spread of ecstasy, especially among clubgoers. Though research showed that ecstasy may have medicinal value as an aid to marital or relationship therapy, it was made illegal in 1985. Later research indicated that ecstasy may also have medicinal value in treating post-traumatic stress disorder and cluster headaches.

In the first decade of the twenty-first century, methamphetamine became a common drug of choice. Since the mid-twentieth century, the two most commonly used recreational drugs have been alcohol and marijuana, especially by youth, with the popularity of other drugs rising and falling.

The recent history of recreational drug use shows that the particular drugs used recreationally have tended to rise and fall according to their fashion for specific times and subcultures. Current trends in the United States likewise vary by age, race, and social class. Among poor children and adolescents, solvent inhalants, especially glues and aerosols, are commonly used recreational drugs. Among poor and working-class urban adolescents and young adults, heroin and crack cocaine are major drugs of choice. Among the rural poor and working class, methamphetamine is common.

For middle-class youth, alcohol, tobacco, and marijuana are the most prevalent. For the professional class, a wide range of so-called designer drugs are used, especially barbiturates, amphetamines, LSD, ecstasy, and ketamine. Most recently, synthetic chemicals that mimic the effects of marijuana have been produced. For many new synthetic drugs, there is initially a lack of an official classification, which keeps the drug legal for a time. However, soon thereafter, government experts generally declare the substance illegal.

Effects and Potential Risks

Given the extremely wide range of drugs that are used recreationally, the number of effects and potential risks is similarly large. It is possible to classify recreational drugs in terms of their effects on cognition, affect, or sensation. Furthermore, it is possible to specify whether they enhance or diminish such capacities.

LSD, for example, is used to enhance cognition, ecstasy to enhance affect, and marijuana to enhance sensation; cocaine and methamphetamine provide both a euphoric affect and a stimulation of cognition, whereas heroin provides a euphoric mood while leading to a drowsy cognitive state; alcohol typically enhances affect while decreasing cognition and sensation, and so forth. Such attempts at classifying the effects of drugs, however, falter upon the dilemma that, for most drugs with psychoactive effects, the exact effects are not universal, but rather vary considerably based upon two factors not tied to the drug itself: the mental state of the user and the setting in which the drug is used.

Just as the effects of so wide a range of drugs cannot be univocally specified, neither can their potential risks. For most drugs, one potential risk is the danger of dependence. Such addictive potential varies considerably across the spectrum of drugs used recreationally. Those that are legal—alcohol, nicotine, and caffeine—have the most widespread patterns of addiction. Among the illegal drugs with the greatest potential for addiction are heroin, cocaine, and methamphetamine. The drug whose use is most commonly prosecuted, marijuana, has been shown to have no addictive potential, though the possibility of a nonphysical, or psychological, dependency among some users remains disputed.

Beyond their addictive potential, many of the drugs used recreationally also pose a range of health risks, especially in the context of long-term heavy use. Alcohol in particular has been linked to organ damage, especially of the liver. Nicotine, when smoked, has been linked to lung cancer. Among illegal drugs, methamphetamine use can lead to brain damage and dental problems; cocaine to cardiovascular problems; and heroin to heart, lung, and liver damage. Many studies show a complex but close association between recreational drug use and mental health problems; combined with genetic factors, many experts believe drug use and mental illness reinforce each other in many cases.

Additional risks arise because of the illegal status of many recreational drugs. For example, additional unknown, harmful effects can arise. Blood-borne diseases are often caused by using needles for intravenous drugs. Also, adulterated or impure substances purchased on the black market can cause serious harm. The risk of arrest and the consequences of a conviction also must be counted among the harms in this category.

Bibliography

Daly, Max. "What Are Recreational Drugs Actually Doing to Our Mental Health?" Vice. Vice Media, 27 Apr. 2015. Web. 30 Oct. 2015.

Fadiman, James. The Psychedelic Explorer’s Guide. Rochester, VT: Inner Traditions, 2011. Print.

Holland, Julie, ed. The Pot Book: A Complete Guide to Cannabis. Rochester, VT: Park Street, 2010. Print.

Nichter, Mark. “Generation RX: Anthropological Research on Pharmaceutical Enhancement, Lifestyle Regulation, Self-Medication, and Recreational Drug Use.” A Companion to Medical Anthropology. Eds. Merrill Singer and Pamela I. Erickson. Malden, MA: Wiley, 2011. Print.

Shapiro, Harry. Recreational Drugs: A Directory. London: Collins, 2004. Print.

How does drug use affect pregnancy?

Drug Use During Pregnancy

For the years 2012 and 2013, 5.4 percent of pregnant girls and women age fifteen to forty-four years, including 8.6 percent of women age eighteen to twenty-five years, admitted to some kind of current illicit drug use, according to the Substance Abuse and Mental Health Services Administration.

Certain factors in the life of a drug-abusing woman contribute to her reluctance to seek help, obtain prenatal care, or to stop using drugs during pregnancy. Many women who exhibit a pattern of drug use have mental, social, and financial problems. These situations contribute to an overall unhealthy routine that may include smoking, poor diet, stress, violence, and unpredictable living conditions, resulting in adverse pregnancy outcomes.

Drug-addicted women frequently are much more likely to smoke cigarettes and to use intravenous drugs during pregnancy, potentially exposing themselves to blood-borne infections. The high rates of mental illness in women who abuse drugs and illnesses that include anxiety, depression, and personality disorders contribute to a high rate of relapse among women who attempt to discontinue drug use while pregnant.

Women who abuse drugs may fail to obtain prenatal care for several reasons. For example, amenorrhea is a common side effect of drug abuse, so a woman may not realize she is pregnant. Drug use can be particularly risky to the fetus during the first eight weeks of pregnancy, a critical period of fetal development. Drug addiction also may lead to forgotten or missed appointments or to a lack of concern regarding the health of the fetus. Women who abuse drugs also endanger their own health through unhealthy lifestyles and relationships that may involve physical abuse, which also risks harm to the fetus.

Cocaine

The 1980s witnessed a significant increase in the use of cocaine
and crack cocaine in the United States. Cocaine remains a serious public health issue in the United States, with the majority of cocaine-using women in their childbearing years.

It has been determined that when a pregnant woman uses cocaine, the drug crosses the blood-brain barrier and the placenta, becoming readily available to the developing fetus. Animal models have shown that cocaine interferes with fetal brain development because it interacts with neurotransmitters and affects gene expression, but the mechanisms for this are unknown. Children exposed to cocaine prenatally have demonstrated deficits in attention span and impulse control, which may be attributed to the effects of cocaine on areas of the brain regulating these functions.

Cocaine is known to be a vasoconstrictor and may contribute to spontaneous abortion and low birth weight from a lack of blood flow to the fetus. Cocaine use during pregnancy, especially crack cocaine, has been linked to deformed arms, legs, and internal organs because of this vasoconstriction effect during fetal development. Lack of blood flow across the placenta also prevents the transport of oxygen and nutrients to the fetus. Infants born to cocaine-addicted women also are more likely to be hospitalized in a neonatal intensive care unit.

Infants are also affected indirectly by their mother’s cocaine use through the effects that use has on the area of the brain that controls maternal behavior. Cocaine disrupts the pathways in the brain that control maternal-infant bonding behavior and disrupts the production of oxytocin, a hormone that is key to triggering response behaviors in mothers.

Other Substances

In addition to cocaine, other frequently misused substances, such as methamphetamine, marijuana, hallucinogens, and opiates, have demonstrated increased risk of premature labor and low birth-weight infants. Methamphetamine
use has grown substantially in the United States, particularly in the western half of the country. Thus far, however, there have been few studies of the effect of methamphetamine use on the developing fetus.

It is known that methamphetamine interacts with biochemical transporters in the brain and is transported directly into cells. Once inside nerve cells, methamphetamine disrupts the release and metabolism of neurotransmitter molecules in the brain, impairing the development of the neurotransmitter system. Methamphetamine is a vasoconstrictor, similar to cocaine, and can have the same effect on the fetus through lack of blood flow.

Magnetic resonance imaging studies of children exposed to methamphetamine in utero have revealed abnormal brain structure in association with neurological developmental deficiencies. Newborn babies prenatally exposed to methamphetamine are usually underweight and have shown similar neurological effects as those exposed to cocaine. Animal models have demonstrated learning deficiencies, behavioral problems, and hyperactivity.

Heroin
is a short-acting opiate that, with repeated use and withdrawal, can cause muscle contractions, leading to premature labor. However, no studies have shown that heroin use during pregnancy causes central nervous system damage in the developing fetus. Opiates cross the placenta, so opiate abusers may give birth to addicted newborns who must subsequently undergo withdrawal. These newborns experience irritability, central nervous system difficulties, gastrointestinal disorders, and respiratory symptoms for up to eight days after birth. As in the case of cocaine, it is difficult to determine if these symptoms are caused by the mother’s heroin use or are consequences of other factors associated with the mother’s lifestyle.

Remedial Actions

It is difficult to attribute specific fetal deficiencies to illicit drug use because of the many other confounding factors in the drug-addicted woman’s life. These factors include smoking and poor nutrition, both of which may adversely affect the pregnancy too.

Residential treatment during pregnancy has demonstrated positive outcomes, but it is unclear if this outcome is from stabilization of the drug use or from an overall healthier lifestyle. Studies have shown that drug-addicted women who receive early intervention and extensive prenatal care and supervision can have pregnancy outcomes equivalent to women who do not use drugs. Comprehensive prenatal care can substantially reduce the risk of premature labor and low birth-weight infants among drug abusers.

It is recommended that pregnant women stop using cocaine during pregnancy, but the cocaine must be reduced in a measured fashion to avoid side effects, such as maternal seizures. Methadone treatment has been found to stabilize opiate abusers during pregnancy by allowing the women to gradually diminish opiate abuse through the pregnancy without the repeated use and withdrawal of heroin. The effect of drug abuse on infant mortality remains to be studied and delineated.

Bibliography

Burgdorf, Kenneth, et al. “Birth Outcomes for Pregnant Women in Residential Substance Abuse Treatment.” Evaluation and Program Planning 27 (2004): 199–204. Print.

Hepburn, Mary. “Substance Abuse in Pregnancy.” Current Obstetrics and Gynaecology 14 (2004): 419–25. Print.

Pinto, Shanthi M., et al. “Substance Abuse During Pregnancy: Effect on Pregnancy Outcomes.” European Journal of Obstetrics and Gynecology and Reproductive Biology 150 (2010): 137–41. Print.

Prentice, Sheena. “Substance Misuse in Pregnancy.” Obstetrics, Gynaecology, and Reproductive Medicine 20 (2010): 278–83. Print.

Roussotte, Florence, Lindsay Soderberg, and Elizabeth Sowell. “Structural, Metabolic, and Functional Brain Abnormalities as a Result of Prenatal Exposure to Drugs of Abuse: Evidence from Neuroimaging.” Neuropsychology Review 20 (2010): 376–97. Print.

Salisbury, Amy L., et al. “Fetal Effects of Psychoactive Drugs.” Clinical Perinatology 36 (2009): 595–619. Print.

Strathearn, Lane, and Linda C. Mayes. “Cocaine Addiction in Mothers: Potential Effects on Maternal Care and Infant Development.” Annals of the New York Academy of Science 1187 (2010): 172–83. Print.

Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville: SAMHSA, 2014. PDF file.

How are retirement and developmental psychology related?

Introduction

Retirement only became an accepted part of modern life in the first half of the
twentieth century, due to increasing longevity and the introduction of
pension and
retirement benefits. Many workers choose to retire when they
become eligible for pension or social security benefits. In the United States, the
possibility of retirement became more accessible with the passage of the Social Security
Act in 1935. From 1900 to 2000, the percentage of men over
the age of sixty-five who continued to work declined as much as 70 percent in the
United States. At the same time, the percentage of all adults over sixty-five who
worked at least part-time steadily increased from 1960. Although the majority of
older Americans do not choose to work after reaching retirement age, more than 18
percent of Americans older than sixty-five were working in 2012 (compared to less
than 11 percent in 1985). Psychologist Frank Floyd and his colleagues, in their
1992 Retirement Satisfaction Inventory, found four primary reasons for retirement:
job stress, pressure from employer, desire to pursue one’s own interests, and
circumstances such as health problems. With an increasing number of older workers
delaying retirement, psychologist Towers Watson and his colleagues at Boston
College's Center on Aging and Work looked at the reasons why American workers
postpone retirement and found that the most common reasons included high debt
loads; reluctance to lose employer-provided benefits, particularly health
insurance; insufficient savings for retirement; care-taking or financial
responsibilities for children and elderly parents; and a desire to remain active
and engaged in the work force.

The retired population is defined as all people aged sixty-five and over.
Traditionally, sixty-five has been the age at which people could retire and
receive full Social Security and Medicare benefits in the United States,
although a law is in place to gradually raise the retirement age to sixty-seven.
Approximately seventy-eight million people belong to the large cohort of baby boomers
who will begin to reach the traditional age of retirement in 2010. In 1900, only
about three million were retired at sixty-five, in 2000 the number increased to
thirty-five million, and it is projected that, by 2050, the number will be
increased to sixty-seven million. If future projections are anywhere close to
accurate, it can be assumed that it will take approximately four working Americans
to provide for every retiree in 2050.

Working during Retirement

Even as individuals near retirement age, the decision to continue working in
some form after retirement or to discontinue work altogether is a complex one.
Many people feel that they have sufficient finances to comfortably exist without
working if that is their preference. The primary determiner for most is their
health status. Employer pension benefits were found to reduce the probability of
future employment in some form, while part-time work was more likely for those who
were limited to Social Security benefits. Spousal influence is often cited by
retirees as a major factor in deciding whether to choose future employment,
although spouses report that they perceive themselves as having little influence
on the decision. Specific training and the job opportunities that are available
within a community are also important in determining postretirement work.

One survey reported that 80 percent of baby boomers expect to work during their retirement years. More than one-third wanted part-time work because they would personally find it interesting or enjoyable. A little less than one-fourth planned to work for financial reasons. In another study, nearly 70 percent planned to work for pay during postretirement because they wanted to stay active and involved.

The probability of working after retirement has a positive correlation with educational attainment and being married to a working spouse. The primary characteristics associated with men who work in their seventies and eighties are good health, a strong psychological commitment to work, and a distaste for retirement.

Retirees in the Work Force

The Retirement History Study by the Social Security Administration identified
four career job exits for postretirement employment: part-time employment in one’s
career job, part-time employment in a new job, full-time employment in a new job,
and full-time retirement. The Age Discrimination in Employment Act of
1967 prohibited firing people because of their age before
they retired, and in 1978, the mandatory retirement age was extended from
sixty-five to seventy. Mandatory retirement was banned altogether in 1986, except
for a few occupations where safety is at issue.

Studies have found older adults tend to be productive participants in the
workforce. They have lower rates of absenteeism, show a high level of job
satisfaction, and experience fewer accidents. There is a cyclic relationship
between higher cognitive ability and complex jobs. Older adults who work in more
complex job settings demonstrate higher cognitive ability, and those with a higher
level of intellectual functioning are more likely to continue working as older
adults. It is also important to note that ageist
stereotypes of workers and their ability can encourage early
retirement or have an adverse effect on the career opportunities given to older
adults.

Adjustment to Retirement

Retirement may represent golden years for some, but not necessarily for all.
Certain factors have been found to have an impact on the degree of satisfaction
retirees experience. Some of these factors are found within society and have an
indirect influence on how life is experienced for those who retire. Other factors
are directly related to specifics in the individual’s life.

Data from longitudinal studies have identified factors that influence
adjustment to retirement. Those who adjust best are more likely to be healthy,
active, better educated, satisfied with life before retirement, have an adequate
level of financial resources, and have an extended social network of family and
friends. Factors that contribute to a less positive adjustment to retirement are
poor health, inadequate finances, and general or specific stress in
various areas of life. Those who demonstrate flexibility typically function better
in the retirement setting in which the structured environment of work is missing.
Individuals who have cultivated interests and friends unrelated to work show
greater adaptation to retirement.

A primary factor in adjustment is whether retirement was voluntary or
involuntary. Forced retirement has been ranked as one of the top ten crisis
situations that cause stress. When retirement is voluntary, adjustment is more
positive. Those who do not voluntarily retire are more likely to be unhealthy and
depressed.

An important aspect of successful adjustment is preretirement planning. Those who are most satisfied with retirement are those who have been preparing for it for several years. Adults can begin preparing psychologically for retirement in middle age. Decisions need to be made relative to activities that will be used to stay active, socially involved, and mentally alert. Of most importance during this time is the task of finding constructive and fulfilling leisure activities that can be continued into retirement. Individuals who are already involved in a number of leisure activities will experience less stress when they make the transition from work to retirement.

During the middle of the twentieth century, disengagement theory was proposed
as the approach older adults used to withdraw from obligations and social
relationships. It was suggested that this would provide enhanced life
satisfaction. Retirement was viewed as part of the disengagement process. Although
this theory has not been considered acceptable for some time, it would be fair to
say that it represented a prevailing belief about older adults during the first
half of the twentieth century.

Researchers have since found support for the activity theory, which is the
exact opposite of disengagement theory. The activity theory proposes that the
more active and involved older adults are, the more likely they are to experience
life satisfaction. Supporting research suggests that activity and productivity
cause older adults to age more successfully and to be happier and healthier than
those who disengage. The theory further suggests that greater life satisfaction
can be expected if adults continue their middle-adulthood roles into late
adulthood. For those who lose their middle-adulthood roles, it is important that
they find substitute roles to keep them active.

Marriage and Family Relationships

Retirement is often a time when adults have sufficient time to develop their
social lives. Aging expert Lillian Troll found that older adults who are embedded
in family relationships have less distress than those who are family deprived.
There is a gender difference in the perspectives of older parents relative to the
importance of support from family members. Women perceived support from children
as most important whereas men considered spousal support as most important.

For married couples, retirement may bring changes for both spouses. When
retirement allows a spouse to leave a high-stress job, marital quality is
improved. In dual-income families, couples may choose to retire simultaneously or
to retire at separate times to ease into the financial changes that retirement may
bring. However, studies have suggested that both husbands and wives report greater
marital satisfaction if they retire at the same time. Retirement may bring about a
significant disruption to established patterns within the home and family, and
couples need to work together to establish new patterns and habits that are
satisfactory to both partners. Some studies have likened the first two years of
retirement to the first two years of marriage or parenthood, in that couples need
to actively renegotiate their roles, plans, dreams, and habits to adapt to the
lifestyle and role changes that retirement brings. Nevertheless, nearly 60 percent
of retired couples report improved marital satisfaction following retirement,
after a period of adjustment.

Work, Retirement, and Leisure

The perception of retirement is affected by work and leisure experiences during
the preretirement years. Leisure refers to the activities and interests one
chooses to engage in when free from work responsibilities. Many find it difficult
to seek leisure activities during the height of their work careers because of the
value placed on productivity and the pressures of many modern jobs. They may view
leisure activities as boring and lacking challenge. Many workers fear a loss of
identity or status with the loss of their jobs; by engaging in enjoyable
activities, volunteer or part-time work, or family, retirees can establish new,
meaningful facets to their identity.

Midlife is the first opportunity many adults have to include leisure activities
in their schedule. This can be an especially appropriate time if they are
experiencing physical changes in strength, endurance, and health as well as
changes in family responsibilities. Those who are able to find constructive and
fulfilling leisure activities during this time are psychologically prepared from
the middle adult years for retirement. Some developmentalists believe that middle
adults tend to reassess priorities and that this becomes a time of questioning how
their time should be spent.

Late adulthood, with its possibility of representing the years from sixty-five
to more than one hundred years, is the longest span of any period of human
development. The improved understanding of the nature of life after sixty-five and
the greater commitment on the part of medical and mental health personnel to the
improvement of health and living conditions for the older adult are giving all
retirees a better chance of being satisfied with the years beyond their work
experience.

Bibliography

Bamberger, Peter, and Samuel B. Bacharach.
Retirement and the Hidden Epidemic: The Complex Link between
Aging, Work Disengagement, and Substance Misuse—And What to Do about
It. New York: Oxford UP, 2014. Print.

Bengtson, Vern L.,
and K. Warner Schaie. Handbook of Theories of Aging. 2nd
ed. New York: Springer, 2009. Print.

Knoll, Melissa A. "Behavioral and
Psychological Aspects of the Retirement Decision." Social Security
Bulletin 71.4 (2011): 15–32. PDF file.

Maddox, H. George
L., Caleb E. Finch, Robert C. Atchley, and J. Grimley Evans, eds.
The Encyclopedia of Aging. 3rd ed. New York: Springer,
2001. Print.

Milne, Derek. The Psychology of
Retirement: Coping with the Transition from Work. West Sussex:
Wiley, 2013. Print.

Pipher, Mary Bray.
Another Country: Navigating the Emotional Terrain of Our
Elders. New York: Riverhead, 2000. Print.

Ryff, Carol D., and
Victor W. Marshall, eds. The Self and Society in Aging
Processes. New York: Springer, 1999. Print.

Vaillant, George E.
Aging Well: Surprising Guideposts to a Happier Life from the
Landmark Harvard Study of Adult Development. Boston: Little,
2003. Print.

Wang, Mo, ed. The Oxford Handbook
of Retirement. Oxford: Oxford UP, 2013. Print.

What is liver cancer? |

Causes and Symptoms

The
liver filters the blood supply, removing and breaking down (metabolizing) toxins and delivering them through the biliary tract to the intestines for elimination with other wastes. Because of the large volume of blood flowing through the liver (about a quarter of the body’s supply), blood-borne toxins or cancer
cells migrating from tumors elsewhere (the process called metastasis) pose a constant threat. In fact, in the United States most liver cancers are metastatic; only about 1 percent actually originate in the liver. In Southeast Asia and sub-Saharan Africa, primary liver cancer is the most common type, accounting for as much as 30 percent of all cancers.

Two major types of cancer affect the liver: those involving liver cells (hepatocellular carcinomas) and those involving the bile ducts (cholangiocarcinomas). The first is by far the more common, although tumors may contain a mixture of both, and their development is similar. Tumors may arise in one location, forming a large mass; arise in several locations, forming nodes; or spread throughout the liver in a diffuse form. Liver cancers occur in men about four to eight times more frequently than in women and in African Americans slightly more than in Caucasians, although the proportions vary widely among different regions of the world. In the United States, most cancers arise in people fifty years old or older; in other areas, people older than forty are at risk.

Primary liver cancer has so much regional and gender variation because causative agents are more or less common in different areas and men are more often exposed. A leading risk factor in the United States and Europe is
cirrhosis, a scarring of liver tissue following destruction by viruses, toxins, or interrupted blood flow. In the United States, long-term
alcohol consumption is the most common cause of cirrhosis, and men have long been more likely than women to become alcoholics. Likewise,
hemochromatosis, a hereditary disease leading to the toxic buildup of iron, is a cancer precursor and more common in men than in women. In Africa and Southeast Asia, the
hepatitis B and C viruses are leading precancer diseases because hepatitis has long been endemic in those areas, whereas in the United States it is not widespread (although the number of infected people began to rise in the 1980s).

Diet and medical therapies have also been implicated as liver carcinogens. Food toxins, especially aflatoxin from mold growing on peanuts (which are a staple in parts of Africa and Asia); oral contraceptives; anabolic steroids; and the high levels of sex hormones used in some treatments are thought to increase the likelihood of hepatobiliary tumors. Genetic factors, radiation, and occupational exposure to volatile chemicals may also play a minor role.

Although researchers generally agree about which agents are liver cancer precursors, the exact mechanism leading to tumor development is not thoroughly understood. Nevertheless, one factor may be universal. Viruses and toxins injure or destroy liver and bile duct cells; the body reacts to repair the damage with inflammation and an increased rate of new cell growth, a condition called regenerative
hyperplasia. If the toxin damage continues, triggering ever more hyperplasia, as is the case with hepatitis and alcoholic cirrhosis, formation of a tumor becomes almost inevitable.

Like lymph nodes, the liver collects migrating cancer cells, so the cancers that physicians detect there often are metastases from cancers arising elsewhere in the body. In fact, liver involvement may be found before the primary cancer has been recognized. Colorectal cancer is especially given to metastasizing to the liver, since the digestive tract’s blood supply is directly linked to the liver through the portal vein; similarly, lung and breast cancer may spread to the liver. Such metastases indicate advanced cancers that do not bode well for the patient’s survival.

Symptoms may be ambiguous. Two common symptoms are jaundice and enlargement of the liver, with accompanying tenderness. Jaundice, a yellowing of the skin and eyes, is caused by an accumulation of bilirubin. Bilirubin builds up because a tumor has blocked the bile duct that normally empties it into the small intestine. (Both symptoms may also occur as a result of either gallstones or cirrhosis.) Patients with liver cancer may also have a fever and retain fluid in the abdominal cavities.

Treatment and Therapy

Doctors suspecting liver cancer conduct tests designed to distinguish this disease from other disorders. Palpation of the liver may reveal that the organ is enlarged or contains an unusual tissue mass, which is likely to be a tumor. A rubbing sound heard through the stethoscope may also come from a tumor. Hepatocellular carcinoma often elevates the alpha-fetoprotein level in blood. Abdominal ultrasound or computed tomography (CT) scans can provide good evidence of a tumor in the liver, and a biopsy will supply a tissue sample capable of proving the presence of cancer, especially if the biopsy is done with CT scan or ultrasound guidance. A tumor can also disrupt normal biochemical action in the body, which doctors may detect in blood tests. Liver function blood tests may be abnormal with both primary and secondary liver cancer.

Under even the most favorable circumstances, the outlook for patients with liver cancer is still not good. If a primary cancer is found while still fairly small, surgical removal is the surest and fastest treatment, although it is a difficult, risky procedure because of the liver’s complex, delicate structure. Radiation and chemotherapy have not succeeded in shrinking tumors effectively. Because symptoms usually appear late in the development of primary liver cancer, it seldom is found early enough for surgical cure; patients usually live only one to two months after detection. Those found with small, removable cancers live an average of twenty-nine months. Most liver cancers are metastases, however, and removal of the liver tumor will not rid the patient of cancer. In general, hepatobiliary cancer patients have low chance of living five years after diagnosis.

Liver cancer screening tests can locate tumors while they are still treatable, although routine physical examinations in Western nations seldom include such tests. Usually only patients with cirrhosis or chronic hepatitis are screened. The best ways to ward off liver cancer are to avoid viral infection and to abstain from alcohol. For those at risk for infection, such as health care workers, the most effective primary prevention is vaccination for hepatitis B. US cases of liver cancer are expected to rise by a factor of four during the second decade of the twenty-first century, primarily because of hepatitis C infections and "fatty liver" (which occurs in patients with diabetes and obesity).

Bibliography

Abou-Alfa Ghassan K., and Ronald DeMatteo. One Hundred Questions and Answers About Liver Cancer. 3d ed. Burlington, Mass.: Jones & Bartlett Learning, 2012.

Curley, Steven A., ed. Liver Cancer. New York: Springer, 1998.

Dollinger, Malin, et al. Everyone’s Guide to Cancer Therapy. 5th ed. Kansas City, Mo.: Andrews McMeel, 2008.

Eyre, Harmon J., Dianne Partie Lange, and Lois B. Morris. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery. 2d ed. Atlanta: American Cancer Society, 2002.

Gu, Jianren. Primary Liver Cancer: Challenges and Perspectives. New York: Springer, 2012.

Liver Cancer Network. http://www.livercancer.com.

Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Adult Primary Liver Cancer. San Diego, Calif.: Icon Health, 2002.

Reau, Nancy, and Fred Poordad. Primary Liver Cancer: Surveillance, Diagnosis, and Treatment. New York: Humana Press, 2012.

Sachar, David B., Jerome D. Waye, and Blair S. Lewis. Pocket Guide to Gastroenterology. Rev. ed. Baltimore: Williams & Wilkins, 1991.

Shannon, Joyce Brennfleck. Liver Disorders Sourcebook. Detroit, Mich.: Omnigraphics, 2000.

Steen, R. Grant. A Conspiracy of Cells: The Basic Science of Cancer. New York: Plenum Press, 1993.

What do Sylvia and the heron have in common?

Sylvia and the heron are both elusive and mysterious creatures.  Sylvia's tendency is to keep to herself and those people she knows well -- like her grandmother and her cow; she is made very uncomfortable by the presence of the hunter at first and even views him as "the enemy."  He is certainly the enemy of the elusive heron.  The hunter's intention is to find and kill this beautiful, white bird and then stuff it...

Sylvia and the heron are both elusive and mysterious creatures.  Sylvia's tendency is to keep to herself and those people she knows well -- like her grandmother and her cow; she is made very uncomfortable by the presence of the hunter at first and even views him as "the enemy."  He is certainly the enemy of the elusive heron.  The hunter's intention is to find and kill this beautiful, white bird and then stuff it to keep in his home. 

Further, both Sylvia and the heron are representative of the fragility of nature.  At one point, when Sylvia realizes that she'll have to tell the hunter her name and take him home with her, "she hung her head as if the stem of it were broken."  She's compared to a fragile flower that can be easily damaged by the hunter and the things that he wants.  One can say the same thing about the birds the young man hunts.  At the end of the story, the narrator describes the "sharp report of his gun and the sight of thrushes and sparrows dropping silent to the ground, their songs hushed and their pretty feathers stained and wet with blood."  It does not take much for the hunter to end the life of the birds he finds so lovely.  In the end, it was Sylvia's first impression of him that is correct, and it is perhaps why the heron eludes him: he is the enemy of the beauty and life in nature.

What does de Beauvoir say about sexual choice and desire in the chapter "Sexual Initiation" in Book Two of The Second Sex? What is the most...

De Beauvior's premise is that sex, for women, is always about becoming "prey" for the man. Sex is always about the objectification of women by men; men are "active" in that they seek to penetrate the woman; women are "passive" in that they are receptacles for male desire. In this way all sex is a kind of rape; women, by virtue of their anatomy, are required to undergo violation.

De Beauvoir traces how this objectification...

De Beauvior's premise is that sex, for women, is always about becoming "prey" for the man. Sex is always about the objectification of women by men; men are "active" in that they seek to penetrate the woman; women are "passive" in that they are receptacles for male desire. In this way all sex is a kind of rape; women, by virtue of their anatomy, are required to undergo violation.

De Beauvoir traces how this objectification is manifest in the psychology of women, with sections dealing with the awakening of desire, loss of virginity, and frigidity. There is a kind of doubleness in feminine sexuality that comes from, on the one hand, the clitoris as the center of sexual pleasure, and, on the other, the vagina as the center of biological reproduction. Perhaps the most memorable section of the chapter, if one can be singled out, is her attempt to distinguish the nature of feminine sexual pleasure from male pleasure. Male pleasure is finite, and has a definite, and biologically significant, end: ejaculation. Female pleasure, however, can take many forms, she argues; a female orgasm is much more indefinite, and the female urge, far from reaching a final goal, as in the male, is rather to achieve a kind of infinite, suffused pleasure.

She concludes by saying that what women envy in men is not, as Freud thought, their penises, but rather their "prey," the power to objectify others. This is perhaps the most significant observation in the chapter; it suggests that while male autonomy is a result of their sexuality, for women this autonomy must be gained in spite of their sexuality.

What is personality theory? |

Introduction

Psychologists who study personality are interested in explaining both the coherence of an individual’s behavior, attitudes, and emotions, and how that individual may change over time. To paraphrase Clyde Kluckhohn, personality theorists seek to describe and explain how each individual is unique, how groups of people meaningfully differ from one another, and how all people share some common attributes. In developing answers to these questions, theorists use widely varying definitions of personality that may differ greatly from the way the term “personality” is used in everyday language. Indeed, if there is a single overriding basic issue in personality theory, it is What is personality?

Personality and Essence

Theorists agree that people have an internal “essence” that determines who they are and that guides their behavior, but the nature of that essence differs from theory to theory. Psychoanalytic theories such as Sigmund Freud’s see the essence of personality as arising from conflict among internal psychic processes. In Freudian psychology, the conflict is viewed as occurring among the urges for instinctual gratification (called the id), the urges for perfection (the superego), and the demands of reality (the ego). Humanistic theories such as those of Carl R. Rogers and Abraham Maslow also see people as often engaged in conflict. For these theorists, however, the conflicts are between an internal self that is striving for positive expression and the constraints of a restrictive external social world. In general, humanistic psychology has a much more optimistic outlook on human nature than does psychoanalytic psychology.

Still other theorists are more neutral with respect to human nature. George Kelly’s cognitive personality theory, for example, views people as scientists, developing and testing hypotheses to understand themselves better and to predict events in their world. Social learning theorists such as Walter Mischel, Albert Bandura, and Julian Rotter see people as developing expectations and behavioral tendencies based on their histories of rewards and punishments and on their observations of others.

To some extent, the question of “essence” is also the question of motivation. Psychoanalytic theorists view people as trying to achieve a balance between instinctual urges and the demands of reality. In contrast, humanistic theorists view people as motivated toward personal growth rather than homeostatic balance. Social learning theory views people as motivated to avoid punishments and obtain rewards.

Related to the question of the “essence” of personality is the notion of whether part or all of the personality can be hidden from the person him- or herself. Psychoanalytic theorists believe that the driving forces of the personality are in the unconscious and thus are not directly accessible to the person except under exceptional circumstances such as those that arise in therapy. Humanists are much more optimistic about the possibility of people coming to know their inner selves. According to Rogers, parts of the self that were once hidden can, when the individual receives acceptance from others, become expressed and incorporated into self-awareness. Social learning theories do not place much weight on hidden personality dynamics. From the social learning perspective, people are viewed as unable to verbalize easily some of their expectations, but no special unconscious processes are hypothesized.

Noimetic psychology, promulgated by Eric R. Maisel, combines some of these elements: unlike the psychoanalytic and social learning theories, it posits that each person is born with an original personality, but as in psychoanalysis and humanism, this personality is unknowable. Rather, the individual's "formed personality" is a product or version of that unknowable personality plus experience, and it is the individual's "available personality" that enables changes in personality.

Personality Change

Theories also differ in the degree to which a person’s personality is seen as changing over time. Most personality theories address the development of personality in childhood and the possibility for change in adulthood. Psychoanalytic theorists believe that the most basic personality characteristics are established by the age of five or six, although there are some minor further developments in adolescence. While the person may change in adulthood in the course of psychotherapy and become better able to cope with the conflicts and traumas experienced during the early years, major personality transformations are not expected. Again, humanists are more optimistic than psychoanalytic theorists about personality change, although humanists, too, see the childhood years as important. For example, Rogers suggests that during childhood the parents may communicate their approval of some of the child’s feelings and their disapproval of others, leaving the child with a distorted self-concept. Yet, from the humanistic point of view, the person’s true inner self will constantly strive for expression. Thus, positive personality change is always seen as possible. Social learning theorists also see personality as changeable. Behaviors learned in childhood may later be changed by direct training, by altering the environment, or by revising one’s expectations.

A final issue is the relationship between personality and behavior. For social learning theorists, behaviors and related expectations are personality. A person’s behaviors are taken as a sample of a full behavioral repertoire that forms who the person is. Both psychoanalytic and humanistic theorists view behavior as a symptom or sign of underlying, internal personality dynamics rather than a sample of the personality itself. According to this viewpoint, a person’s behaviors reflect personality only when interpreted in the light of the underlying traits they reveal. Diverse behaviors may thus be related to a single internal characteristic.

Personality Measures

The study of personality is a scientific discipline, with roots in empirical research; a philosophical discipline, seeking to understand the nature of people; and the foundation for the applied discipline of psychological therapy. While these three aspects of personality often support and enrich one another, there are also tensions as the field accommodates specialists in each of these three areas.

The approach that focuses on personality as a scientific discipline has produced an array of methods to measure personality characteristics. They range from projective tests, such as having people tell stories inspired by ambiguous pictures, to more standardized paper-and-pencil personality tests in which people respond on bipolar numerical or multiple-choice scales to questions about their attitudes or behaviors. Methodologically, personality testing is quite sophisticated; however, people’s scores on personality tests often are rather poor predictors of behavior. The poor record of behavioral prediction based on personality traits, coupled with evidence that suggests that behavior does not have the cross-situational consistency that one might expect, has led Mischel and many other personality specialists to question the utility of most traditional personality theories. Social learning approaches, which emphasize the power of the situation in determining a person’s behavior, tend to fare better in these analyses.

Predicting Behavior

Yet research has found circumstances under which people’s behavior can be predicted from knowledge of their underlying personality characteristics. If one classifies personality characteristics and behaviors at a very general level, combining observations and predicting a group of behaviors, prediction improves. For example, predictions would be more accurate if several measures of a person’s conscientiousness were combined, and then used to predict an overall level of conscientious behavior in a variety of situations, than if one measured conscientiousness with a single scale and then attempted to predict behavior in one specific situation. Prediction on the basis of personality traits also improves when the situations in which one seeks to predict behaviors allow for individual variation as opposed to being highly constrained by social norms. Five basic personality traits often emerge in investigations: extroversion, agreeableness, conscientiousness, emotional stability, and culture (high scores on culture reflect characteristics such as intelligence and refinement). Some researchers view these trait terms as accurately describing consistent personality differences among people, while others view them as reflecting the “eye of the beholder” more than the core of personality.

Ultimately, people’s personality traits and situations interact to produce behavior. Situations may often determine behavior, but people choose to place themselves in specific situations that elicit their traits. A child with a predisposition to aggression may provoke others and thus set the stage for the expression of aggression; one who is highly sociable may seek out others in cooperative situations. The relation between personality and behavior is very complex, and it is difficult to describe fully using standard research methods.

Research is highly unlikely to answer philosophical questions concerning human nature; however, considering people from the different points of view offered by various theories can be an enriching experience in itself. For example, a Freudian perspective on a former US president, Lyndon B. Johnson, might see his leadership during the Vietnam conflict as guided by aggressive instincts or even sublimated sexual instincts. On the other hand, a humanist might look at Johnson’s presidency and find his decisions to be guided by the need for self-fulfillment, perhaps citing his vision of himself as the leader of the Great Society as an example of self-actualization. Social learning theorists would view Johnson’s actions as president as determined by the rewards, punishments, and observational learning of his personal learning history, including growing up relatively poor in Texas and accruing power and respect during his years in the US Senate, as well as by the reinforcements and punishments Johnson perceived to be available in the situations in which he found himself during his presidency. In the final analysis, none of these interpretations could be shown to be blatantly false or absolutely true. Historians, biographers, and others might find each to be an enriching viewpoint from which to consider this complex individual.

Therapy

Multiple points of view also characterize the therapies derived from theories of personality. Most therapists take an eclectic approach, sampling from the ideas of various theories to tailor their treatment to a specific client. Each therapist, however, also may have her or his own biases, based on a particular theoretical orientation. For example, a client who often feels anxious and seeks help from a psychoanalytic therapist may find that the therapist encourages the client to explore memories of childhood experiences to discover the unconscious roots of the anxiety. Slips of the tongue, dreams, and difficulty remembering or accepting therapeutic interpretations would be viewed as important clues to unconscious processes. The same client seeking treatment from a humanistic therapist would have a different experience. There, the emphasis would be on current experiences, with the therapist providing a warm and supportive atmosphere for the client to explore feelings. A behavioral therapist, from the social learning orientation, would help the client pinpoint situations in which anxiety occurs and teach the client alternative responses to those situations. Again, no one form of therapy is superior for all clients. Successes or failures in therapy depend on the combination of client, therapist, and mode of treatment.

Theories and Experimentation

While people have long speculated on the causes and types of individual differences in personality, the theory of Freud was the first and most influential psychological personality theory. All subsequent theories have directly or indirectly addressed the central concerns of motivation, development, and personality organization first proposed by Freud. Psychoanalytic theorists such as Carl Jung and Alfred Adler, while trained by Freud, disagreed with Freud’s emphasis on sexual instincts and developed their own theories, emphasizing different motivations. Similarly, Karen Horney, Erich Fromm, and others developed theories placing greater emphasis on the ego and its interaction with society than did Freud’s.

Psychoanalytic theory has had somewhat less of an influence in the United States than it did in Europe. Personality psychology in the United States is relatively more research-oriented, practical, and optimistic. In the United States, Gordon Allport developed one of the first trait approaches to personality. The humanistic theories of Carl R. Rogers and Abraham Maslow, the social learning theories of Bandura and Rotter, and the cognitive theory of Kelly flourished in the 1950s and 1960s and continue to have their advocates. Modern personality psychologists, however, are much more likely to confine themselves to personality measurement and research than to propose broad theories of personality.

Many have questioned personality’s status as a scientific subdiscipline of psychology. In 1968, Mischel’s Personality and Assessment, arguing that the consistency and behavior-prediction assumptions inherent in all personality theories are unsupported by the evidence, was published. At the same time, attribution theories in social psychology were suggesting that personality traits are largely in the “eye of the beholder” rather than in the person being observed. For example, Edward Jones and Richard Nisbett argued that people are more inclined to see others as possessing personality traits than they are to attribute traits to themselves. The continued existence of personality as a subdiscipline of scientific psychology was debated.

The result has been a refined approach to measurement and personality analysis. Current research on personality does not boldly assert the influence of internal personality characteristics on behavior. Rather, attention is paid to careful assessment of personality and to the complex interactions of persons and situations. For example, research on loneliness has found that people who describe themselves as lonely often lack social skills and avoid interactions with others, thus perpetuating their feelings of loneliness. All personality characteristics, including loneliness, are most meaningfully seen as the product of a complex interrelationship between the person and the environment.

Bibliography

Arroyo, Daniela, and Elias Delgadillo. Encyclopedia of Personality Research. Hauppauge: Nova Science, 2012. Print.

Ewen, Robert B. An Introduction to Theories of Personality. New York: Psychology, 2010. 239–86. Print.

Fiske, Susan T., and Patrick E. Shrout. Personality Research, Methods, and Theory. New York: Taylor, 2014. Print.

Hall, Calvin S., Gardner Lindzey, and John B. Campbell. Theories of Personality. 4th ed. New York: Wiley, 1998. Print.

Hampden-Turner, Charles. Maps of the Mind. New York: Macmillan, 1982. Print.

Jackson, Marc-Antoine, and Evan F. Morris. Psychology of Personality. Hauppauge: Nova Science, 2012. Print.

Maisel, Eric R. "What Is Your Original Personality?." Psychology Today. Sussex, 27 Nov. 2011. Web. 1 July 2014.

Mischel, Walter. Introduction to Personality: Toward an Integrative Science of the Person. 8th ed. Hoboken: Wiley, 2008. Print.

Mischel, Walter. Personality and Assessment. 1968. Reprint. Hillsdale: Analytic, 1996. Print.

Pervin, Lawrence A., Richard W. Robins, and Oliver P. John, eds. Handbook of Personality: Theory and Research. 3rd ed. New York: Guilford, 2008. Print.

Storr, Anthony. Churchill’s Black Dog, Kafka’s Mice, and Other Phenomena of the Human Mind. New York: Ballantine, 1990. Print.

What are natural treatments to improve well-being?

Introduction

It is one of the cardinal principles of natural medicine that treatment should aim not only to treat illness but also to enhance well-being, or wellness. According to this ideal, a proper course of treatment should improve the sense of general well-being, enhance immunity to illness, raise physical stamina, and increase mental alertness; it should also resolve specific medical conditions.

While there can be little doubt that this is a laudable goal, it is easier to laud it than to achieve it. Conventional medicine tends to focus on treating diseases rather than on increasing wellness, not as a matter of philosophical principle, but because it is easier to accomplish.

One strong force affecting wellness is genetics. Beyond this, commonsense steps endorsed by all physicians include increasing exercise, reducing stress, improving diet, getting enough sleep, and living a life of moderation without bad habits, such as smoking or overeating. However, it is difficult to make strong affirmations, and the optimum forms of diet and exercise and other aspects of lifestyle remain unclear. They may always remain unclear, as it is impossible to perform double-blind, placebo-controlled studies on most lifestyle habits.

Principal Proposed Natural Treatments

Although no natural treatments have been proven effective for enhancing overall wellness, two have shown promise: multivitamin-multimineral tablets and the herb Panax ginseng.

Multivitamin-multimineral supplements. To function at their best, humans need good nutrition. However, the modern diet often fails to provide people with sufficient amounts of all the necessary nutrients. For this reason, the use of a multivitamin-multimineral supplement might be expected to enhance overall health and well-being, and preliminary double-blind trials generally support this view.

For example, in one double-blind study, eighty healthy men between the ages of eighteen and forty-two were given either a multivitamin-multimineral supplement or placebo and followed for twenty-eight days. The results showed that the use of the nutritional supplement improved several measures of well-being. Similarly, an eight-week, double-blind, placebo-controlled study of ninety-five people with careers in middle management also found improvements in well-being. Furthermore, several studies have found that multivitamin-multimineral supplements can improve immunity in older people. General nutritional supplements may also help improve response to stress.

Panax ginseng. The herb Panax ginseng has an
ancient reputation as a healthful tonic. According to a more modern concept
developed in the former Soviet Union, ginseng functions as an adaptogen. An
adaptogen helps the body adapt to stresses of various kinds, whether heat, cold,
exertion, trauma, sleep deprivation, toxic exposure, radiation, infection, or
psychologic stress. In addition, an adaptogen causes no side effects, is effective
in treating many illnesses, and helps return an organism toward balance no matter
what may have gone wrong.

From a modern scientific perspective, it is not truly clear that such things as adaptogens actually exist. However, there is some evidence that ginseng may satisfy some of the definition’s requirements.

Several studies have found that ginseng can improve the overall sense of well-being. For example, such benefits were seen in a twelve-week double-blind trial that evaluated the effects of P. ginseng extract in 625 people. The average age of the participants was just under forty years old. Each participant received a multivitamin supplement daily, but for one set of participants, the multivitamin also contained ginseng. Level of well-being was measured by a set of eleven questions. The results showed that people taking the ginseng-containing supplement reported significant improvement compared to those taking the supplement without ginseng.

Similarly positive findings were reported in a double-blind, placebo-controlled study of thirty-six people newly diagnosed with diabetes. After eight weeks, participants who had been taking 200 milligrams of ginseng daily reported improvements in mood, well-being, vigor, and psychophysical performance that were significant compared to the reports of control participants.

A twelve-week, double-blind, placebo-controlled study of 120 people found that ginseng improved general well-being among women aged thirty to sixty years and men aged forty to sixty years, but not among men aged thirty to thirty-nine years. This finding is possibly consistent with the traditional theory that ginseng is more effective for older people. Other results suggest this as well. A double-blind, placebo-controlled trial of thirty young people found marginal benefits at most, and a sixty-day, double-blind, placebo-controlled trial of eighty-three adults in their mid-twenties found no effect.

In addition, ginseng has shown some potential for enhancing immunity, mental function, and sports performance. These are all effects consistent with the adaptogen concept.

Other Proposed Natural Treatments

Besides P. ginseng, certain other herbs are regarded as adaptogens, including Eleutherococcus senticosus (Siberian ginseng), Rhodiola rosacea, ashwagandha, astragalus, suma, schisandra, and the Asian mushrooms maitake, shiitake, and reishi. Meaningful supporting evidence for their benefits, however, is scant. In one of the better studies, a small, double-blind, placebo-controlled trial of R. rosacea, the herb seemed to improve physical and mental performance and sense of well-being in students under stress.

Although garlic is not generally regarded as an adaptogen, one study
found that garlic powder (but not garlic oil) enhanced well-being. However,
another study failed to find such benefits with garlic powder.

So-called green juices made from such substances as spirulina and
wheat
grass are widely marketed for enhancing well-being. A
double-blind study found that the use of one such product improved general
vitality, but so did placebo, and the differences between the outcomes in the two
groups were marginal.

Levels of the hormone dehydroepiandrosterone (DHEA) naturally decrease with age, and for this reason DHEA supplements have been widely hyped as a kind of fountain of youth. However, several studies have found that DHEA supplementation does not improve mood or increase the general sense of well-being in older people. A relatively large (about five hundred participants) double-blind study also failed to find selenium helpful in the elderly. Also, a smaller study failed to find evidence that vitamin B12 improved the general sense of well-being among elderly people with signs of mild B12 deficiency.

In some branches of alternative medicine, low levels of thyroid hormone are believed to be a common cause of impaired well-being. As part of this theory, it is said that the most commonly used medical form of thyroid replacement therapy (thyroxine, also called T4) is inadequate. Supposedly, better results are obtained when T4 is taken with the thyroid hormone known as T3, often in the form of “natural thyroid” extracted from animal thyroid glands. However, a double-blind study of 110 people designed to test this theory failed to find combined T3-T4 more effective than T4 alone.

Practitioners and other proponents of yoga have long claimed that its gentle
stretching exercises, special breathing techniques, and deep meditative states
enhance overall health. However, there is only limited evidence that yoga improves
general well-being and quality of life.

Numerous other alternative therapies are claimed by their proponents to improve
overall wellness, including acupuncture, Ayurveda,
chiropractic, detoxification, homeopathy,
massage, naturopathy, osteopathic manipulation,
Reiki, Tai Chi, therapeutic
touch, traditional Chinese herbal medicine,
and yoga. However, there is little meaningful evidence to support these
claims.

Bibliography

Dayal, M., et al. “Supplementation with DHEA: Effect on Muscle Size, Strength, Quality of Life, and Lipids.” Journal of Women’s Health 14 (2005): 391-400.

Ellis, J. M., and P. Reddy. “Effects of Panax ginseng on Quality of Life.” Annals of Pharmacotherapy 36 (2002): 375-379.

Graat, J. M., E. G. Schouten, and F. J. Kok. “Effect of Daily Vitamin E and Multivitamin-Mineral Supplementation on Acute Respiratory Tract Infections in Elderly Persons.” Journal of the American Medical Association 288 (2002): 715-721.

Kjellgren, A., et al. “Wellness Through a Comprehensive Yogic Breathing Program.” BMC Complementary and Alternative Medicine 7 (2007): 43.

Oken, B. S., et al. “Randomized, Controlled, Six-Month Trial of Yoga in Healthy Seniors: Effects on Cognition and Quality of Life.” Alternative Therapies in Health and Medicine 12 (2006): 40-47.

Rayman, M., et al. “Impact of Selenium on Mood and Quality of Life.” Biological Psychiatry 59 (2006): 147-154.

What is epidemiology? |

Science and Profession

Although epidemiology is closely related to medicine, there are significant
differences between the two fields. The main focus of medicine is to diagnose and
treat diseases in individuals, while the core purpose of epidemiology is to
identify factors that cause health problems and control diseases in populations.
The health of a population is the responsibility of the field of public health,
and epidemiology is a tool for public health. Epidemiology studies
disease distribution in populations (for example, how often a disease occurs in
different groups of people), examines determinants of diseases or risk factors
that increase the risk for disease development, and evaluates strategies to
prevent and control diseases in communities.

Diseases have certain patterns in populations. Some groups of people are at a
higher risk for a particular disease. For example, smokers are at a higher risk
for lung cancer. A key feature of epidemiology is the measurement of disease
outcomes in relation to a population at risk. The concept of a population at risk
can be explained by the traditional epidemiological triangle model. In this model,
the three angles are agent, host, and environment. The interrelationship of these
three factors is the basis of development of disease in the population.

In the triangle model, the agent is the cause of the disease and includes four
main categories: biological, physical, chemical, and nutritive. Biological agents
are often infectious. The common infectious agents that cause disease are
bacteria, viruses, and parasites. Physical agents are related to mechanics,
temperature, radiation, noise, and so forth. Chemical agents are often linked to
poisons and air or water pollution. Nutritive agents are the macronutrients and micronutrients that the human body needs. Excess or
deficiency in these nutrients can cause health problems.

The second aspect in the triangle model is the host—the intrinsic factors that
influence exposure, susceptibility, or response of an individual to an agent. Such
intrinsic factors include age, gender, ethnic group, immunity, heredity, and
personal behavior. For example, older age increases the risk for many diseases,
such as heart disease and stroke. Certain ethnic groups also have increased risks
for certain diseases, such as a high incidence of breast cancer in Jewish
women.

The third component of the triangle model is the environment, which consists of
the surroundings and conditions external to the individual that allow disease
transmission or occurrence. The environment consists of physical, biologic, and
socioeconomic components. Geology and climate are some examples of physical
environment. Biologic environment may include population density, age
distribution, and food sources. Socioeconomic environment may
include degrees of industrialization and urbanization, use of technology, job
security, cultural practices, and the availability of health care.

The primary mission of epidemiology is to investigate the interrelationship among
agent, host, and environment of a disease in a population and disrupt the
connection at some point in the triangle, so that the disease can be prevented.
Some typical epidemiological activities include identification and surveillance of
individuals and populations at risk for diseases, monitoring of diseases over
time, identification of risk factors associated with diseases, recognition of
disease transmission mode, and evaluation of the effectiveness of public health
programs.

A specialist of epidemiology is an epidemiologist, who usually possesses a
graduate degree in epidemiology with additional training in disease, public
health, and biostatistics. The main responsibility of an epidemiologist is to
investigate all elements contributing to the occurrence or absence of a disease in
populations. Epidemiologists may work at all levels of communities, including
academic or research institutions, federal governmental agencies, state health
departments, and local health organizations or medical centers.

Diagnostic and Treatment Techniques

The techniques or methods that epidemiologists use to investigate diseases in populations are epidemiological studies, which mainly consist of cross-sectional studies, case-control studies, and cohort studies.

Cross-sectional studies are also called descriptive epidemiology, because this
method describes the distribution of diseases or health-related events and the
exposure status of risk factors in terms of person, place, and time. Describing
disease distribution by person allows epidemiologists to determine the disease
frequency and which populations are at greatest risk. Populations at high risk for
a disease can be identified by investigating such characteristics as age, gender,
race, education, occupation, income, living arrangement, health status, smoking
status, physical activity level, medication use, and access to health care.
Disease frequencies can be observed specifically for any of these characteristics
by different classifications. For example, hypertension occurrence can be observed
by physical activity levels, such as low, medium, and high. Through comparisons of
hypertension frequency among the three levels of physical activity, the group with
the highest hypertension rate can be identified.

Describing disease distribution by place can provide information associated with
the geographic extent of the disease. This information includes county, state,
country, birthplace, and workplace. Identifying place allows epidemiologists to
examine where the causal agent of disease resides and how the disease is
transmitted and spread. Describing distribution by time can reveal any seasonality
of the disease and trends over time. Some diseases may be more common during a
certain season; for example, influenza is more likely to be seen in winter and
early spring. By tracking disease trends over time, changes in disease
distribution, either emerging or declining, can be documented, and corresponding
measures can be taken in response to these changes.

From a cross-sectional study, a group of people with an increased risk for a disease may be identified. The next step is to ask why this group of people has a higher risk for the disease. To answer this question, epidemiologists use case-control studies and cohort studies. Both of these methods are considered analytical studies, as they examine the relationship between a disease and its possible risk factors.

A case-control study begins with the selection of a group of cases—the case group,
individuals who have the disease or health-related outcome of interest. Then,
through interviews or medical records, epidemiologists collect information about
the previous exposure of case group members to possible risk factors. Because
case-control studies obtain information about risk factors in the past, they are
also called retrospective studies. Certain demographic variables, such as age,
gender, race, occupation, education, and residence, are collected as well and are
used as the criteria to select the control group by matching the control subjects
to the cases as closely as possible with respect to the demographic variables. No
individuals of the control group should exhibit the disease or health-related
outcome under investigation. Information on previous exposure to risk factors is
also collected from the controls.

Matching controls to cases allows the investigators to ignore the demographic variables and focus on risk factors in the analysis. Control subjects can match the cases individually or as a group. The ratio of cases to controls can be one to one, one to two, or more. Increasing the number of controls can increase the power of the study to detect the differences between cases and controls; however, a large number of controls can increase the cost of the study as well.

The case and control groups are then compared for previous exposure to the risk
factors of the disease using statistical analyses. The association and the
strength of association between risk factors and the disease under investigation
are evaluated. The results of a case-control study may be a positive association,
in which the risk factors increase the chance of seeing the disease; a negative
association, in which the risk factors decrease the frequency of the disease; or
no association, in which no relationship is found between the risk factors and the
disease. For example, to study whether obesity is associated with type 2 diabetes,
the researcher would select a group of diabetic cases and a group of controls who
do not have diabetes but have similar demographic variables, such as age, gender,
and occupation. Next, the history of weight would be assessed though interviews of
both cases and controls. The weight history of the diabetic cases would then be
compared to that of the nondiabetic controls. In this example, one would be likely
to see a positive association between obesity and diabetes, which means that
obesity is more frequently seen in the diabetic cases.

Cohort studies are used to examine the causal relationship between a disease or health-related outcome and its risk factors. The cohorts, or groups being studied, are identified by characteristics of risk factors exhibited by subjects prior to the appearance of the disease under investigation. Thus, one cohort may consist of subjects with risk factors for a disease, while another cohort may include subjects without such risk factors. In both cohorts, no subjects should have the disease under investigation at the beginning of the study. The research would then follow both cohorts for a set period of time; therefore, cohort studies are also called prospective studies or longitudinal studies.

During the follow-up period of a cohort study, the difference in the occurrence of
the disease under investigation will be recorded and compared between the two
cohorts. The results of a cohort study may also be positive, negative, or no
association, as determined through statistical analyses. A positive association
means the incidence of the disease is increased in the cohort with the risk
factors. A negative association indicates that the incidence of the disease is
decreased in the cohort with the risk factors, which can then be hypothesized to
protect individuals from getting the disease—“good” risk factors. If no
statistical differences are identified between the two cohorts, then the risk
factors are not associated with the disease. A cohort study might study the
relationship between cholesterol level and coronary artery disease. Individuals
with a high cholesterol level would be included in one cohort, and individuals
with a normal cholesterol level would be included in another cohort. Then, both
cohorts would be followed up for a period of ten years. At the end of ten years,
the incidence of coronary artery disease that has been diagnosed during that time
would be evaluated and compared between the two cohorts. In this study, it is very
likely that the cohort with a high cholesterol level would have a higher incidence
of coronary artery disease during the ten years of follow-up. A cohort study with
only two cohorts is the simplest design, but a study may use more than two
cohorts, as long as each cohort has the unique risk factor characteristics.

There are advantages and disadvantages to both case-control studies and cohort
studies. Cohort studies observe a disease from cause to effect and thus generate
more accurate results; however, they are time-consuming and expensive.
Case-control studies are quick and inexpensive, but their results are less
accurate, since they are based on self-reported past experiences, which often
encounter recall biases. In practice, epidemiologists often carry out a
case-control study first. If the study shows a significant association, then a
cohort study is used to confirm the association.

Perspective and Prospects

Literally translated from Greek, epidemiology means “the study of
people”—the population-level study of disease. Epidemiology began with
eighteenth-century London physician John Snow, who investigated an epidemic
of cholera in the city. By observing and plotting the location of deaths related
to the disease, Snow was able to demonstrate that cholera was spread through
contaminated water and food.

In its early years, epidemiology was mainly used to study epidemics of infectious
diseases, because infectious diseases were the major cause of death in populations
at that time. Through improvements in nutrition, sanitation, and living standards,
as well as advances in medicine, the major cause of death has shifted from
infectious diseases to noninfectious or chronic diseases in developed countries.
Epidemiology has now been applied to chronic diseases as well as conditions such
as cancer, heart disease, diabetes, and injuries. The Framingham Heart Study is a
famous epidemiological study of cardiovascular disease in residents of Framingham,
Massachusetts. Epidemiological methods have been approved as a powerful tool to
study diseases or other conditions in populations and have also been applied to
other fields, such as sociology.

In the future, the use of epidemiological methods will continue to increase, allowing a better understanding of more human diseases and their causes. Because of improved medical technologies, epidemiology has been able to combine traditional observational methods with laboratory tests. New branches of epidemiology have been created, such as molecular epidemiology and genetic epidemiology. Research in these areas will yield knowledge about human diseases at a new level.

Bibliography

Centers for Disease
Control and Prevention. Epidemiology and Prevention of
Vaccine-Preventable Diseases. 12th ed. Atlanta: Centers for
Disease Control and Prevention, 2012. Print.

Day, Ian N. M., ed.
Molecular Genetic Epidemiology: A Laboratory
Perspective. New York: Springer, 2002. Print.

Fletcher, Robert H.,
and Suzanne W. Fletcher. Clinical Epidemiology: The
Essentials. 5th ed. Baltimore: Lippincott, 2014.
Print.

Foxman, Betsy.
Molecular Tools and Infectious Disease Epidemiology.
Burlington: Academic, 2012. Print.

Friis, Robert H., and Thomas A. Sellers.
Epidemiology for Public Health Practice. 5th ed.
Burlington: Jones & Bartlett, 2013. Print.

Gordis, Leon.
Epidemiology. 5th ed. Philadelphia: Saunders/Elsevier,
2013. Print.

Lilienfeld, David E.,
and Paul D. Stolley. Foundations of Epidemiology. 3rd ed.
New York: Oxford UP, 1994. Print.

Newman, Stephen C.
Biostatistical Methods in Epidemiology. New York: Wiley,
2001. Print.

Porta, Miquel, ed.
A Dictionary of Epidemiology. 6th ed. New York: Oxford
UP, 2014. Print.

Rothman, Kenneth J. Epidemiology:
An Introduction. 2nd ed. Oxford: Oxford UP, 2012.
Print.

What is quadriplegia? |

Causes and Symptoms

Quadriplegia may result from spinal cord injury, especially in the area of the fifth to seventh cervical vertebrae. Such injury usually follows trauma or vertebral pressure on the soft tissue of the cord. Damage causes flaccidity in the arms and legs, as well as loss of power and sensation below the level of injury. Spinal cord injuries above the fifth cervical vertebra dramatically affect other body systems as well.

For example, cardiovascular complications result from a block in the sympathetic nervous system that allows the parasympathetic system to dominate. One possible complication is hypotension (blood pressure below 90/60) resulting from vasodilation, which allows blood to pool in the veins of the extremities and thereby slows the venous blood return to the heart. Another complication is low body temperature (96 degrees Fahrenheit or lower) from the inability of blood vessels to constrict efficiently, allowing constant close blood vessel contact with the body surface and consequent heat loss. Bradycardia (slow heart rate) may occur from stimulation of the heart by the vagus nerve and absence of the inhibiting effects of the sympathetic system. A decrease in peristalsis, the movement of food through the gastrointestinal system, results from various types of shock. Respiratory complications, a major cause of death, may occur from damage to the upper cervical cord. Autonomic dysreflexia may occur in injuries above the fourth thoracic vertebra, in which a severed connection between the brain and the spinal cord produces an exaggerated autonomic response to such stimuli as distended bladder, fecal impaction, infection, decubitus ulcers, or surgical manipulation. The key symptom of autonomic dysreflexia is hypertension (high blood pressure).

A complete physical and neurologic examination must assess remaining motor function and determine if the cord injury is complete or partial. Detailed information about the trauma may help health care providers anticipate other related injuries. Computed tomography (CT) scans can identify fractures, dislocations, subluxation, and blockage in the spinal cord. X-rays of the head, chest, and abdomen can rule out underlying injuries. Since this type of injury has such far-reaching physiologic effects, significant laboratory data assessing respiratory, hepatic (liver), and pancreatic functions are necessary to provide a baseline.

Treatment and Therapy

The treatment of quadriplegia begins at the scene of the accident, with immobilization of the neck and spine. At the hospital, methods of immobilization include insertion of Gardner Wells tongs or halo traction. A turning frame helps prevent pulmonary complications such as atelectasis (partial lung collapse), pneumonia, and pulmonary embolism; cardiovascular complications such as blood clot formation and orthostatic hypotension; and other complications such as kidney stones, muscle atrophy, decubitus ulcers, and infections.

After stabilization, therapy consists of steroids, intravenous glycopyrrolate to maintain the integrity of the gastrointestinal tract, insertion of a Foley catheter, and administration of a potent diuretic such as mannitol. This treatment regimen is followed for ten days to decrease spinal cord edema (swelling). Unchecked edema further compromises the blood supply to sensitive cord tissue, producing irreversible cord damage. Prevention of ascending cord edema preserves higher cord segments and maximum function in the upper extremities. Each cord segment preserved means greater potential for rehabilitation.

After ten days of therapy, surgical fusion stabilizes the unstable spine. Surgery must also remove bone fragments that can irritate the spinal cord and, in later stages, aggravate spasticity. Another necessary part of treatment is aggressive respiratory therapy that, in the intubated patient, includes instillation of three to five milliliters of normal saline solution and bagging the patient before thorough suctioning to remove secretions and prevent mucus plugs. In cervical cord injuries above the fifth vertebra, intubation and ventilator assistance are always necessary.

Bibliography

Asbury, Arthur K., et al., eds. Diseases of the Nervous System: Clinical Neuroscience and Therapeutic Principles. 3d ed. New York: Cambridge University Press, 2002.

Berczeller, Peter H., and Mary F. Bezkor. Medical Complications of Quadriplegia. Chicago: Year Book Medical, 1986.

Christopher and Dana Reeve Foundation. "Paralysis Resource Center." Christopher and Dana Reeve Foundation, 2013.

Mayo Clinic. "Spinal Cord Injury." Mayo Clinic, October 22, 2011.

MedlinePlus. "Paralysis." MedlinePlus, August 9, 2013.

Rowland, Lewis P., ed. Merritt’s Textbook of Neurology. 12th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.

Smith, Nathalie. "Quadriplegia and Paraplegia." Health Library, March 15, 2013.

Victor, Maurice, and Allan H. Ropper. Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw-Hill, 2009.