f:\12000 essays\health & humanities (196)\100.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Sonnet 69 Can you feel it as my lips touch your skin Ready to share our everlasting love You whisper my name as we are to begin A rose lies by our side, white as a dove Our bodies respond to the lightest touch Your hands touch my skin, and run through my hair We can not hold back, we want it so much We hold eachother happy to be there Your skin glistens as your instincts come out Here, now, our anxiety fills the air The pace quickens and together we shout The wildness leaves us as we melt with despair We hold eachother now, and all is fine Now our hearts beat together, yours with mine f:\12000 essays\health & humanities (196)\14 ELEMENTS OF A SUCCESSFUL SAFETY & HEALTH PROGRAM .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 14 ELEMENTS OF A SUCCESSFUL SAFETY & HEALTH PROGRAM Element 1: Hazard Recognition, Evaluation and Control. Establishing and maintaining safe and healthful conditions required indenifing hazards, evaluating their pontential effects, developing ways to eliminate or control them and planning action priorities.This process is the essence of successful safety and health management. Element 2:Workplace Design and Engineering Safety and health issues are most easily and economically addressed when facilities, processes and equipment are being designed. Organizations must incorporate safety into workplace design, production processes and selection.They also need to evaluate and modify or replace exisiting processes, equipment and facilities to make them safer. We explore how the design and function of the workplace can complement safety and health goals, minimize exposure to hazards and promote safe practices. Element 3: Safety Performance Management As in all areas of operations, standards must be set for safety performance. They should reflect applicable regulatory requirements, additional voluntary guidelines and best business practices. We describe how managers, supervisors and employees can be made responsible and held accountable for meeting standards within their control. We look at how job performance appraisals can reflect performance in safety and health, as well as in other areas. Element 4: Regulatory Compliance Management The Occupational Safety and Health Administration (OSHA), the Mine Safety and Health Administration (MSHA) and state safety and health agencies establish and enforce safety and health regulations.Other agencies, such as the Environmental Protection Agency, also issue and enforce regulations relating to safety and health in the United States. We discuss key aspects of international regulations in the European Union, Canada and Mexico. Staying informed about and complying with regulations are essential goals of safety and health programs.We also look briefly at conducting regulatory compliance inspections. Element 5: Occupational Health Occupational health programs range from the simple to the complex. At a minimun, such programs address the immediate needs of injured or ill employees by providing first aid and responce to emergencies. More elaborate medical services may incude medical surveillance programs and provision for an in-house medical capability. In addition, some companies are beginning to focus on off-the-job safety and health through employee wellness and similar programs. ELEMENT 6: Information Collection Safety and health activities, including inspections, record keeping, industrial hygine surveys and other occupational health assessments, injury/illness/incident investigations and performance reviews, produce a large quantity of data. Safety and health professionals must collect and analyze this data. Small incidents often provide early warning of more serious safety or health problems. Complete and accurate records can be used to identify hazards, measure safety performance and improvement, and through analyses, help identify patterns. ELEMENT 7: Employee Involvement Design and engineering controls are limited in their ability to reduce hazards. Companies now understand that their real assets are people, not machinery, and they also realize that employees must recognize their stake in a safe and healthful workplace. As employees become more involved in planning, implementation and improvement, they see the need for safer work practices. Solutions to safety and health problems often come from affected employees. We look at how employees can contribute to safety and health objectives through safety committees and teams. ELEMENT 8: Motivation, Behavior, and Attitudes Movtivation aims at changing behavior and attitudes to create a safer, healthier workplace. This elements describe two general approches organizations use to motivate employees and stresses the role that visible management leadership plays in changing unsafe or unhealthy behaviors and attitudes. It also describes three motivational techniques: communications, incentives/awards/recognition and employee surveys. ELEMENT 9:Training and Orientation New and transferred employees must become familiar with company policies and procedures and learn how to perform thier jobs safely and efficiently. The use of on-the-job, classroom and specialty training can contribute to a successful safety and health program. A complete program includes hazard recognition, regulatory compliance and prevention. The training is reinforced through regular follow-up with both new and veteran employees. ELEMENT 10: Organizational Communications Effective communication within the organization keeps employees informed about policies, procedures, goals and progress. We see how to spread the word about safety and health programs inside the company through the use of bulletin board notices,newsletters, meeting and other devices. Effective two-way communications between employees and managers is critical as is publicizing safety and health information in the community. ELEMENT 11:Management and Control of External Exposures Todays safety and health programs must address risks beyond the organizations walls. We described the kinds of contingency plans and "what if" worst-case scenarios that are part of planning for disasters, contractor activities and product and other liability exposures. ELEMENT 12:Environmental Management Environmental management often requires a complete program of its own and is addressed in a separate volume, 7 Elements of Successful Environmental Program, available from the National Safety Council. Many companies, however, address environmental issues along with safety and health as part of their comprehensive programs. We discuss the minimum that an environmental program should cover, including compliance monitioring and contingency planning for emergencies. More aggressive environmental management incorporates pollution prevention and an active role in environmental improvement. ELEMENT 13:Workplace Planning and Staffing Safety and health considerations are important when planning for and staffing the companys work force. We consider issues such as work safety rules, employee assistance programs and requirements resulting from the American with Disabilities Act. ELEMENT 14:Assessments, Audits, and Evaluations Every organizations needs tools to measure conditions, monitor compliance and assess progress. A variety of evaluative tools can be used to meet the needs of the organizations, including self- assessments, third-party assessments and voluntary regulatory assessments. Numerous resources are available for conducting assessments audits and evaluations, including the companys own trained internal staff, consultants and OSHA and other agencies. The Continuous Improvement Model is a framework for safety presented in the National Safety Councils Agenda 2000 Safety Health Environment Program. The 14 Elements are the materials that fit within the framework. Continuous improvement is a process-oriented business approach that emphasizes the contributions people make to long-range, permanent solutions to problems. It is the cornerstone of total quality management. Applying the process that forms the Contiinuous Improvement Model requires understanding causes before designing solutions.Improvements may be dramatic or incremental. In any event, the model helps ensure that occur regularly. The Continuous Improvement Model Phase 1: Management Commitment and Involvement The first phase is to make a management commitment and to gain managements involvement. Companies with successful safety and health programs have active senior management participation. Without this active involvement, mid-level managers and front-line supervisors tend to ignore safety and health as an issue. Senior management signals its commitment by stating a position that is communcated through clear, unambiguous policy and implementation procedures. When management supports the 14 Elements, it also indicates a broad commitment to the issues include in the reviews. It then supports continuous improvement in safty and health through ongoing involvement, allocation of resources and feedback. f:\12000 essays\health & humanities (196)\38 Assisted Suicides.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Washington Post 38 Assisted Suicides September 2-8, 1996 Picture yourself in this situation. You go to the doctor for a routine physical. You look fine. You feel good. All those exhausting workouts at the gym are finally starting to pay off and you actually stuck to that low fat, high vitamin diet you're doctor recommended. You have never felt better. You are essentially the epitome of a healthy, fit human being. Then, out of nowhere, you are diagnosed with a disorder of the nervous system accompanied by chronic fatigue syndrome. The illness is permanent and there is no cure. It will only progress and worsen with time, and all you can do is wait. What would you do? If you were 42-year-old Judith Curren, a nurse and mother of two small children, you'd be in close contact with the infamous suicide assessor, Dr. Jack Kevorkian, a.k.a. "Doctor Death," discussing your "options." However, according to an editorial published in The Washington Post, entitled "38 Assisted Suicides," many people believe that when it comes to matters such as life and death, there are no options. The decision to live or die is made by God. Judith Curren didn't agree. With the assistance of Dr. Kevorkian, she died and the retired pathologist presided at his 38th assisted suicide, fairly confident that he will not be prosecuted or even suffer public disapproval. Many of the people who have sought out Dr. Kevorkian have been terribly ill and suffering, with no hope of long-term survival. Their stories offered examples that built public sympathy for this cause. But from the beginning, even among observers who believe that the desperately sick should be given help to die, there have been questionable cases. For example, a woman in her fifties allegedly suffering from early Alzheimer's disease was fit enough to play tennis with her adult son shortly before dying. Another- said to have had a painful, progressive illness-was found to be free of disease by the county medical examiner. The article argued this point, "Is it in any way merciful, compassionate, or 'healing' (a favorite word of Kevorkian fans) to assist in the suicide of a middle-aged woman who is tired and depressed and married to a man whom she recently accused of attacking her and who then delivers her to Dr. Kevorkian? Pain is controllable. Depression and fatigue can be ameliorated by drugs. Violent husbands can be prosecuted and divorced. Suicide in such a case is unreasonable. A doctor's help in that course is unconscionable." I had mixed feelings on this editorial because I take into consideration both sides of the argument. On one hand I understand Judith Curren's decision. I can imagine what it must feel like to wake up perfectly healthy and have your whole life in front of you, and in the next minute be told you have an incurable disease and that it's going to eventually kill you. Living with that thought alone would be too much for me. Here's a woman that did everything right. It just doesn't seem fair that she will never see her children grow up, she will not be able to continue her career in nursing and help save other's lives, she will not be around when the scientists celebrate finding a cure for the disease that claimed her life. In many ways, this woman has suffered enough. Why prolong the inevitable and possible pain and suffering that will escalate with time? As humanitarians, we should want to put this woman out of her misery. But fortunately or unfortunately, there is another side to us. One that wants to be strong and hold on for just a little bit longer. One who believes they will be the first cured when science makes another medical breakthrough. A side that wants to raise it's children instead of watching over them. I believe, for most people, this stronger, more powerful side will conquer death and reinstate hope. After all, life is the most valuable gift we have, and there shouldn't be any two sides to that. f:\12000 essays\health & humanities (196)\A Method to Memory.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ A Method to Memory The other night I was sitting at home in my room watching the Rockets game, and my phone begins to ring. I answer "Hello", and I hear this frantic voice that I recognize as my friend Mandy's. Mandy is a nervous wreck, she has a big bio-chem test in the morning and can't seem to remember a thing. I ask her what kind of information she has, and she tells me she has notes and her book. Now being the nice guy I am, and having just completed learning about memory in my Intro to Psych class, I turned off the T.V. and told her I'd help her learn to memorize things. The first thing I told her about was a method called rehearsal. I explained that rehearsal involved repeating the information time after time to keep it from fading from her short term memory, or STM. She was a bit confused so I simplified it for her. I reminded her of the other night when she was looking for the number to Pizza Hut in the phone book, and when she found it she started repeating over and over until she got to the phone and could dial it. She was astounded that she was doing this all along and didn't even know it. I then explained another short term memory method known as chunking. She cringed and thought I was talking about the keg party the other night, but I explained that chunking involves taking a large number or word and breaking it down into smaller pieces that could be remembered easier. I also told her that she could chunk together the first letters of a phrase to make it more accessible to her memory retrieval system. I gave her the example of the New York Stock Exchange, or N.Y.S.E. That helped her a lot, but she was concerned whether or not she would remember it all for the final, so I told her the more rehearsing she did, the deeper she would commit the information to memory. She was so happy, she told me she had to go and study for this test. I had never heard someone so excited to study. About a week later Mandy came up to me after psych class and told me she got an A on her test. She said she owed me and she took me out to lunch. She even told me that she remembered almost everything she studied and she would do well on all her tests thanks to me and my Intro to Psych class. f:\12000 essays\health & humanities (196)\Abortion and my own thoughts.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ John Harvell English 110U February 12, 1997 A-B-O-R-T-I-O-N and my own thoughts What would it be like to die so young and so fragile? What would it be like to kill something so young and so fragile? Abortion, in my definition, is the taking of a life. Now it is hard for me to sit here and type this paper when I know good and well that if my daughter or wife were ever raped I would want whatever was inside of them out -- immediately. I think that to take the life of an unborn just because the couple involved were too lazy to use contraceptives, is immature and quite horrid. In this informative paper, you as a reader will come to understand the facts on abortion and then understand where I stand. Let us begin. According to US Abortion data provided in 1995 by Planned Parenthood, there were 1.8 million first trimester abortions, 180 thousand second trimester abortions, and about four thousand required Hysterotomies. Now according to these figures we, as the United States, killed/aborted 1,984,000 fetus'. Sure we could keep down the increase in our population at this rate, but where would we be emotionally? Speaking from a "my" point of view, I wouldn't get to far. I enjoy children profusely and thinking that there are 1.9 million children less in the world every year sends shivers down my spine. But I guess you may say that it is not my place to speak. There are fewer deaths per million abortions than per million births according to the Planned Parenthood survey of 1995. There are nine deaths per million abortion procedures and sixty-three deaths per million births. Both complications and the death rate rise with the age of the fetus. I can understand that these facts portray a much better picture for abortion than carrying to term, but what about the pain that the fetus will feel? According to pro-choice physicians they believe that a certain connection, synaptic, necessary to perceive pain, for the fetus, is not formed until the twenty-eighth week of pregnancy. Others who are pro-life believe that the fetus can feel pain as early as the seventh week. But even though these facts by Planned Parenthood show a better side to abortion as well, nothing can compare to the guilt of the "Post-traumatic abortion syndrome" right? Wrong. According to Dr. Paul Sachdef, professor of social work at Memorial University in Newfoundland, Canada, long term guilt or depression was rare in the seventy in-depth interviews that he conducted of women ages eighteen to twenty-five, single, and white. These classifications of the women interviewed represented the largest group of women seeking abortions. He also found that two-thirds of the women used contraceptives rarely or not at all. Three-fourths of the women thought they would not become pregnant. Almost eighty percent "felt relief and satisfaction" soon after the abortion. He also found the elective abortion is much less traumatic for the parent/s than an elective adoption. June Scandiffino disagreed with the good doctor's findings. She believes that Post-traumatic abortion syndrome does not set in until perhaps seven years after the abortion. I would like to believe both findings but I find that it would be hard not to feel some loneliness and some guilt immediately after having an abortion. What do you think? My English professor gave me this assignment, to investigate a subject of interest that we know little about but have wanted to learn more about and then present it, but I kind of cheated on it. I know a good amount about abortion, emotionally, but I don't know a lot of the facts. I know what the main points are and that I always hated when someone would bring up the subject of abortion and then ask my opinion. I have a real split opinion. As for the percentage of abortions dealing with rape and incest -- go for it. If my daughter or wife were ever subject to either one of these I probably would consent to having an abortion and then going out and killing the bastard who did it. As for the percentage of abortions that concentrate around the health of the fetus/ and finding that the fetus has an irreparable disease or body malfunction that would mean bringing a neurologically impaired child, or a deformed child into this world than I would, as well, consider an abortion. There are probably several other "percentages" that once confronted with them I would change my feeble mind. When you hear about all the bombings or incidents of arson on abortion clinics you, well at least I do, wonder what those people involved with those incidents would do if confronted with something of the magnitude of rape or something. I think a lot of those minds would change. Because I know that if I found that I was the product of rape, I probably would want to kill myself. You? My final statement is this, "I am usually pro-life and if there is anyway of keeping and supporting a healthy child than do it. For new life comes around only once in a while." f:\12000 essays\health & humanities (196)\Abortion and the Mentally Handicapped.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Matt Domin MWF 9:00 Abortion and the Mentally Handicapped Ms. Smith, We of the Ethics Committee have reviewed your case for an extended period of time. We took into consideration, for our decision, the yearn of any female to experience childbearing, child birth, and the joy of raising young. Being a mother is a once-in-a-lifetime opportunity, and once you become a mother you are a mother for life. There is a tremendous amount of responsibility and work that goes along with having children. We understand your desire to continue the pregnancy, and to keep the child, but due to your legal status, mental health, and the baby's well being, the decision to terminate the pregnancy has been reached and voted for unanimously. Your mother has proper legal custody, and as you know, wants the abortion to take place. We agree with her concern for your well-being. Child birth is an extremely stressful situation. The trauma of the pregnancy could intensify your paranoid schizophrenia, or cause some other mental disorder. Mrs. Smith has informed us that she herself is not capable of caring for the child. We feel that you will suffer further if you are forced to give up the child. Your psychiatrist has come to the conclusion that you are not capable of being a responsible parent, but you are, at times, capable of making rational moral decisions. However, because you are not able to make important, rational, moral decisions most of the time your mother can claim that you are not mentally capable of raising a child. Also. We took in to account that the father of this unborn child is unknown. There is no one to help you make this decision, but more importantly, there is not another parental figure to aid in the raising and caring for this child. From testimonies from your mother and your psychiatrist, it is our understanding that you can do neither on your own. Ms. Smith, you have been diagnosed with paranoid schizophrenia. As you know, the treatment for paranoid schizophrenia is a variety of different drugs. This gives you a slightly higher chance of having fetal defects such as cystic fibrosis, pulmonary emphysema, abruptioplacentae, miscarriage, or placenta previa to name a few. We also feel that there is an increased chance that the child will develop a mental disorder. It is not fair for the child or its' care takers to suffer from deformities that were caused from drug reactions. You must understand our position in caring for the physical health and safety of this child. You will not be able to provide for the child, because you have no annual income. We feel that the child will not have equal opportunities to have positive growth and development because of this. Living in Community Hospital's long term care unit does not provide a heathy environment for the baby to live in. The baby will have little opportunity to go outside, be with peers, and have friends. A baby needs a healthy environment to grow and be nurtured in. This is a basic right that should be granted to any new born. We feel that because of your living situation your baby will not get the essentials. Adoption is another issue to be dealt with. As we stated earlier, you might suffer more if you are you are forced to give the baby up for adoption. You could possibly develop serious depression, and worsen your paranoid schizophrenia. You may think you give the child up for adoption to benefit their well being, but once you actually give birth to this child, your feelings may change. The could cause serious emotional trauma on you, your mother, and in the long run will hurt your child. Orphanages aren't the best environment for a child to grow up in. If you did put your child up for adoption, the likelihood that someone will want to adopt a mental patient's child is low, and if the child is deformed in some way the chance is even smaller. You took the responsibility to have sex, now you must take the responsibility to do what is right for your child, no matter how much pain will be placed on you. Every child deserves to have loving, providing parents and we feel you can't give your child that, and an adoption may not be successful. We, as an Ethics Committee are not willing to take that chance with an unborn child's life. Children's development is influenced by several different mediums like environment, parents, friends, and personal characteristics. We feel that if this child were born under these circumstances, the influences presented would be negative, and the baby's well being, health, and security are top priority in this case. Being an ethics committee, we cannot permit you to give birth to this fetus. You are not mentally capable to bear, or properly raise the child. Your lifestyle is not suitable for properly raising a child. Living in a mental hospital does not provide an acceptable environment for a baby to grow in, and the negatives of this case out way the positives. We are truly sorry about this decision, but it is the best for you and the child. We will do our best to help you in any way. We are here to offer mental and physical support. Please understand that this is the best solution for everyone involved. If you have any problems or questions feel free to contact us any time. We did not impose this decision to hurt you in any way. We want you to get healthy and care for yourself. Until you can care for, and have responsibility for yourself, you can't care for and take responsibility for another. This decision is final and you must cooperate with us to make this painful situation as easy as possible. We have sent a copy of this letter to your mother and to your doctors and we would like to talk with you further. Thank You for your cooperation. Sincerely, The Ethics Committee f:\12000 essays\health & humanities (196)\Abortion Persuasive.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 101-36 Persuasive Essay 9/22/96 Abortion, the easiest way to fix one's mistakes. I mean, if one is going to screw around and accidentally get knocked up, why should they have to be responsible for the outcome of messing around. Why not just murder the unborn child. That is what goes on daily, slaughtering of young, innocent children, that if born, would easily find a home. What did they [the unborn child] do wrong? Oh nothing, it's just that the mother and/or father are just so lazy and irresponsible that they would rather see their child be butchered than have to change it's diaper or feed it. Society today does not respect life and therefore accepts the murdering of unborn children. A major factor that is missing is society in today's world are moral values. If people actually had morals, then abortion might not occur. No matter what anyone argues, abortion is murder, plain and simple. How could one deny that when a doctor grabs his forceps and crushes a child's skull and sucks out what was once a brain, how could they say that is not murder, how could someone get away with doing this. Then again people ask that same question about OJ. There are many abortion-slaughter techniques that are used today. Examples are the Dilatation and Curettage (D&C) where a loop shaped steel knife is inserted and the child is cut into pieces, also their is the Dilatation and Evacuation (D&E) where the doctor uses forceps with sharp metal jaws and tears the child apart, piece by piece. Usually the head is hardened to bone and must be compressed or crushed in order to get it out. Another highly controversial technique that is getting a lot of publicity nowadays is the partial birth method. This procedure in performed in the second and third trimesters of pregnancy or between 20 to 32 weeks, sometimes later. Now according to Abortion: Some medical facts, a book printed by the National Right to Life, the partial birth technique is performed like this: "Guided by ultrasound, the abortionist reaches into the uterus, grabs the unborn baby's leg with forceps, and pulls the baby into the birth canal, except for the head, which is deliberately kept just inside the womb. ( At this point in a partial -birth abortion, the baby is alive.) Then the abortionist jams scissors into the back of the baby's skull and spreads the tips of the scissors apart to enlarge the wound. After removing the scissors, a suction catheter is inserted into the skull and the baby's brains are sucked out. The collapsed head is then removed from the uterus." Now I don't see a difference between the partial-birth method and say me going up to someone and stabbing them over and over again. The only difference is the outcome, were I would be charged with murder for committing such a crime , but the "doctors" that perform the 1.5 million murders a year get paid and some even praised. Hopefully people will wake up and see that abortion truly is murder. The opposition usually contests that women have the right to terminate their pregnancy whenever they want. Now I was taught that one could not have a right that conflicts with the rights of others, therefore the claim that women have such a right is irrelevant. Most uninformed people think that the majority of abortions are performed because the woman's life is in danger, well that is not fact. Fact is that 93% of all induced abortions are done for elective, nonmedical reasons. To make it simple, they are just irresponsible, they are murders and will have to live with that for the rest of their lives. f:\12000 essays\health & humanities (196)\Abortion Report.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Abortion Report I have chosen for my topic Abortion. I think that it is a topic that is very important in today's society however it is often dodged or avoided. Different Presidents say different things and have different stances about it, and often it is had to know what to think about it. Basically there are two different ways of looking at it: Pro-Choice, which takes the stance of saying that it is the woman's choice if she wants to have an abortion and that it is only her business. So basically they want it to remain legal. Then there is the other stance of Pro-Life which says that it should not remain legal and that it is just about as bad as cold-blooded murder. I happen to agree with this. This is what I will be focusing on for the rest of my report. I will first talk about Pro-Choice. Through the years this has obviously been the thinking of our nation because abortion remains legal (Bill Clinton is Pro-Choice). This is also the thinking of many woman's rights movements and organizations. From reading a paper on Pro-Choice it states as its heading that abortion should be a woman's right to choose what she does with her body, and it should not be altered or influenced by anyone else. This right is guaranteed by the ninth amendment, which contains the right to privacy. This brings up a very interesting point, which is that the ninth amendment is a strong argument in the fight for Pro-Choice. It states that "The enumeration in the Constitution, of certain rights, shall not construed to deny or disparage others retained by the people." This right guarantees the right to women, if they so choose, to have an abortion, up to the end of the first trimester. Several cases have been fought for the right to choose. Many of these have been hard cases but they stuck with it, and many people believe that that is why we have some of the rights we do today. Here are some important cases: 1. 1965 - Griswold vs. Connecticut. Upheld the right to privacy and ended the ban on birth control. Eight years later, the Supreme Court ruled the right to privacy included abortions. 2. 1973 - Roe vs. Wade. The state of Texas had outlawed abortions. The Supreme Court declared the law unconstitutional, bur refused to order an injunction against the state. On January 22, 1973, the Supreme Court voted the right to privacy included abortions. 3. 1976 - Planned Parenthood vs. Danforth. Ruled that requiring consent by the husband and the consent from a parent if a person was under 18 was unconstitutional. This case supported a woman's control over her own body and reproductive system. To conclude about Pro-Choice I will state what Dana Pentoney has said: Abortion deals with one's private life and should have nothing to do with the government. However, abortion should not be used as a means of birth control, but if a fetus will be unwanted, it is better to be aborted than to be abused or neglected. Now onto Pro-Life. This is what Presidential hopeful Bob Dole believed in, and to start it off I will give some interesting facts on how our views on Abortion have changed throughout the years. Asking the simple question What is Abortion? Here are the answers that you would have gotten: 1859 - The slaughter of countless children; no mere misdemeanor or no mere attempt upon the life of the mother, but the wanton and murderous destruction of her child; such unwarrantable destruction of human life. 1871 - The work of destruction; The wholesale destruction of unborn infants. 1967 - The interruption of an unwanted pregnancy. 1970 - A medical procedure. There are many different methods of abortion each one more horrible than the last. Some of them include: -Suction Abortion -Dilation and Curettage (D&C) -Dilation and Evacuation (D&E) -Salt Poisoning (Saline Injection) -Hysterotomy -Prostaglandin Abortion There are also many risks and complications caused by having an abortion. Some of the more widely known one's are: 1. Breast Cancer 2. Complications in future pregnancies, including excessive bleeding, premature delivery, cervical damage, and sterility. 3. Pelvic inflammatory disease (PID). 4. Uterine perforations. 5. Tubal pregnancy. 6. Placenta previa, which is extremely severe, life threatening bleeding in future pregnancies. 7. Retention of placenta As you can see there are many different factors that contribute to abortion, and many different risks that you take in having one. I think that abortion will remain a huge topic that's not going to go away easily. I believe that they should be illegal however through doing this report I have been shown the other side of the story, the Pro-Choice side, and I have began to see there standpoint-even though I might not agree with it. f:\12000 essays\health & humanities (196)\Abortion should be made illegal.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Abortion should be made Illegal Abortion should be made Illegal Abortion should be made illegal. Abortion is murder, it is the killing of an unborn baby. In today's society, regular people are not allowed to go out and just murder someone for no reason, so why should doctors be allowed to murder unborn babies? "Abortion is not merely the removal of some tissue from a woman's body....Abortion is the destruction of an unborn baby." (O'Connor 93) According to John C. Willke, president of the National Right to Life Committee, "At the union of sperm and ovum there exists a living, single-celled, complete human being." Therefore, according to what John C. Willke says, abortion at ANY stage of pregnancy is the immoral taking of human life and should be illegal. "The bible makes it clear that to God the unborn child developing inside the womb is far more than mere fetal tissue. He inspired King David to write: "Your eyes saw even the embryo of me, and in your book all its parts were down in writing." (Young 25-27) The bible (Exodus 21:22, 23) has clearly stated that a person would be held accountable for hurting an unborn baby. (Young 25-27) Take this for example; Say a woman is walking down the street carrying a child in her arms. Another woman is walking down that same street carrying a child, only this woman is carrying the child in her. Both children are dependent on their mothers, both just dependent in different ways. (Schwarz 35) Take another example "Suppose a woman suffers a miscarriage, A sympathetic doctor will not tell her, "You have lost your fetus"; he will say; "You have lost your child"." (Schwarz 35) If an abortion is picked the term "fetus" is used as a cold scientific "neutral" word which switches the persons mind from reality, and also will flip the seriousness, and preciousness of a unborn baby. (Schwarz 35) Can it be so possible in today's society that we "get so caught up trying to be sensitive to the woman and her suffering that we forget the baby altogether." (Gallagher 63)) People today do not want to see a young persons "life" ruined because of an unwanted pregnancy, so they see their only choice is abortion. (O'Connor 94) Many people in today's society do not accept capital punishment, they feel it is not humane. Before capital punishment is even considered, the human is given a fair chance of trial by jury, and if found guilty -- then administered the death penalty. (O'Connor 98) "Yet many people who reject capital punishment accept, support and consider it a :right: to take the life of an innocent unborn baby, who has never had a trial or been found guilty." (O'Connor 98) Is it not ironic that in a hospital a doctor will work for hours trying to save the life of a premature baby, but then in another room a doctor will work to end the life of another. The political laws will allow the doctor to kill the baby inside the mother's womb, but outside the womb this would be called Murder. (Awake! 3-5) "According to one study, 87 percent of teenagers who have abortions fear the having a baby would dramatically change their lives in a way they are not prepared to accept." (Young 25-27) Many people will agree that abortion is wrong, but than they will consider abortion if a woman is raped. Many studies today show that pregnancy from rape is very rare. " One survey of 3,500 consecutive victims of rape in Minneapolis, U.S.A., yielded not a single case of pregnancy. Of 86,000 abortions in the former Czechoslovakia, only 22 were for rape. Thus, only a tiny portion of those seeking abortions do so for these reasons." (Awake! 3-5) "From 50 million to 60 million unborn babies perish each year by abortion. Can you comprehend that number? It would be like sweeping the entire population of the Hawaiian Island off the map every week!" (Awake! 6-9) "In the United States, abortion is the second most common surgical procedure, next to tonsillectomy. Annually, over 1.5 million abortions are performed." (Awake! 6-9) "In what was the Soviet Union, abortions are estimated at 11 million annually, among the highest number worldwide." (Awake! 6-9) As we can see the main topics that people use today to say that Abortion should remain legal is all contradicted. Many people state the right of a Woman, but we can see the fetus in her is not just a fetus, it is a developing human being. We also see that the bible states that God knows us as an embryo. Many studies were taken, and show some very interesting information about abortions. In conclusion, Abortion should be made illegal. Abortion has been shown to be murder by not just the most important book today, The Bible, but also many scientists. Bibliography Cozic, Tipp, ed., Abortion Opposing Viewpoints, California, Greenhaven Press. Inc., 1991. "Young People Ask... Abortion--Is it the Answer?," Awake!, March 8, 1995, p.25-27. "The Abortion Dilemma--Are 60 Million Killings the Solution?," Awake!, May 22, 1993, p.3-5. "Abortion's Tragic Toll," Awake!, March 22, 1993, p.6-9. Pictures from: Dr. J.C. Willke, Mrs. J.C. Willke, Abortion Questions and Answers, Ohio, Hayes Publishing Company, Inc., 1985. f:\12000 essays\health & humanities (196)\Abortion.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Points of View It is nearly impossible anymore to find someone who doesn't have an opinion about abortion, and probably a strong opinion at that. Yet the endless debates on the topic usually go nowhere, leaving the opponents even more committed to their positions and the open-minded observers confused. Both sides make a good case. An unwanted child is a pitiful thing, and the attendant social problems (single motherhood, financial destitution, child neglect, and urban overcrowding, to name just a few) do not have easy solutions. On the other hand, the thought of terminating something that, if left to run its natural course, would ultimately result in the birth of a human being gives all but the most hard-hearted among us cause for serious introspection. One reason the debate goes nowhere is that each side focuses on a different topic. We make no progress because we are not talking about the same thing. The pro-abortionist prefers to discuss choice, and to dwell on all of the social problems inherent in an unwanted child. The anti-abortionist is interested primarily in protecting the life of the fetus. In simple terms, the pro-abortionist focuses on a woman's rights and the anti-abortionist focuses on a fetus' rights. Though interrelated, these are basically different topics. Though neither side realizes it, there is actually much more agreement than disagreement between the opposing views. The majority on both sides would agree that social problems like child neglect and urban overcrowding are serious issues. Most would also agree that the life of a child is a precious thing that deserves the full protection of the law. There would even be nearly universal agreement that it is a woman's exclusive right to make decisions concerning her body. So where's the disagreement? The entire complex issue comes down to one question: Is the fetus a person? If you believe it is not a person, then it is simply part of the woman's body and subject to her exclusive control. From this point of view, any attempt to diminish that control is a cruel infringement upon a woman's rights. If, however, you believe the fetus is a person, then you are obligated to protect it, even to the point of delimiting the actions of the woman carrying it. For you, the suggestion that this issue is a matter of personal choice is like saying that whether or not a parent kills a two-year-old is a matter of personal choice. The goal of these pages is to examine the abortion debate from several perspectives, focusing on the question of when the fetus' life as a person begins. Toward that end I have divided my presentation into four areas: History, Medicine, Law, and Bible. History provides insight into how other people and cultures have approached this issue. Medicine discusses scientific evidence relating to the topic. Law considers how the Constitution bears on this debate and the role of the court in it. Bible examines the teachings in this area of one of the fundamental moral guides for Western culture. Throughout each of the specific areas I have endeavored to honestly reflect views from both sides. But I make no pretense of being unbiased. No one who spends any time considering this issue can be truly impartial. Instead I admit my position freely, but try to avoid letting it cause me to misrepresent the alternatives. If you feel that I have missed something significant, please let me know. I hope to refine the content of these pages over time to make them more useful. f:\12000 essays\health & humanities (196)\Acupuncture.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Acupuncture Acupuncture is a Chinese medical practice that treats illness and provides local anesthesia by the insertion of needles at predetermined sites of the body. Acupuncture may also follow many other forms. The word acupuncture comes from the Latin word acus, meaning needle, and pungere, meaning puncture. The Chinese call acupuncture Chen Chiu. On doing my research over acupuncture I used many different sources. I got most of my information from the Internet. I discovered a large acupuncture clinic in Houston and contacted them over the phone. I never really realized that acupuncture was used so much in this country, but there are many places acupuncture is used in the United States. Acupuncture is used in the treatment of a wide variety of medical problems. It is used for ear, nose, and throat disorders, respiratory disorders, Gastrointestinal disorders, Eye disorders, and Neurological and Muscular disorders. The needles used in acupuncture are usually only inserted from 1/4 to 1 inch deep into the skin. There is usually no pain in acupuncture. Usually if any pain it is only mild. Most of the needles now used in acupuncture are disposable needles. Acupuncture does not always only involve needles. They may also use other methods such as moxibustion, cupping, electronic stimulation, magneotherapy and various types of massage. There are also many different styles of acupuncture practiced all over the world. There are many things to consider when choosing an acupuncturist. Acupuncture is a licensed and regulated healthcare profession in about half the states in the United States. There are many acupuncture practices which are not certified, so when choosing one some research is required. If you get acupuncture usually between five to fifteen sessions are required, depending on the severity of the complaint. Many acute conditions only require a single treatment. The main thing to remember when receiving acupuncture is to simply relax. After acupuncture treatments much of the pain may be gone after the first treatment, or in some cases it takes more. In some cases the pain may become worse, this is known as the rebound effect. The clinic I got most of my information from is a clinic in Houston. They specialize in Acupuncture Therapy for diseases and conditions such as acute and chronic pain, degenerative diseases, arthritis, M.S., post-stroke, migraine headaches, lower back pain, facelifts, weight reduction, and smoking control. The Dr. that performs acupuncture at this clinic is Dr. Duong Hoang (M.D.), C.A. The fees vary according on types of treatment. And usually a complete physical examination is required before your first acupuncture session. Through my research over this topic I learned many things. I never really realized that acupuncture was such a big business. It is becoming more and more popular all over the world. In Canada acupuncture is very common, and seems to be becoming more common in the United States. f:\12000 essays\health & humanities (196)\Adolecence.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Adolescence is the developmental stage between childhood and adulthood; it generally refers to a period ranging from age 12 or 13 through age 19 or 21. Although its beginning is often balanced with the beginning of puberty, adolescence is characterized by psychological and social stages as well as by biological changes. Adolescence can be prolonged, brief, or virtually nonexistent, depending on the type of culture in which it occurs. In societies that are simple, for example, the transition from childhood to adulthood tends to occur rather rapidly, and is marked by traditionally prescribed passage rites. to contrast this, American and European societies the transition period for young people has been steadily lengthening over the past 100 years, giving rise to an adolescent subculture. As a result of this prolonged transitional stage a variety of problems and concerns specifically associated with this age group have developed. Psychologists single out four areas that especially touch upon adolescent behavior and development: physiological change and growth; cognitive, or mental development; identity, or personality formation; and parent-adolescent relations. Physiological Change: Between the ages of 9 and 15, almost all young people undergo a rapid series of physiological changes, known as the adolescent growth spurt. These hormonal changes include an acceleration in the body's growth rate; the development of pubic hair; the appearance of axillary, or armpit, hair about two years later. There are changes in the structure and functioning of the reproductive organs; the mammary glands in girls; and development of the sweat glands, which often leads to an outbreak of acne. In both sexes, these physiological changes occur at different times. This period of change can prove to be very stressful for a pre-teen. For during this stage of life appearance is very important. An adolescent child who develops very early or extremely late can take a lot of ridicule from his or her peers. However, the time at which a girl goes through this stage and a male goes through it are different. Girls typically begin their growth spurt shortly after age 10. They tend to reach their peak around the age 12, and tend to finish by age 14. This spurt occurs almost two years later in boys. Therefore boys go through a troubling period where girls are taller and heavier than them. This awkward period occurs from ages ten and one-half to thirteen. Time is not the only difference in the pubescent period for boys and girls. In girls, the enlargement of the breasts is usually the first physical sign of puberty. Actual puberty is marked by the beginning of menstruation, or menarche. In the United States, 80 percent of all girls reach menarche between the ages of eleven and one-half and fourteen and one-half, 50 percent between 12 and 14, and 33 percent at or before age 11. The average age at which menstruation begins for American girls has been dropping about six months every decade, and today contrasts greatly with the average age of a century ago, which is between 15 and 17. Boys typically begin their rapid increase in growth when they reach about twelve and one-half years of age. They reach their peak slightly after 14, and slow down by age 16. This period is marked by the enlargement of the testes, scrotum, and penis; the development of the prostate gland; darkening of the scrotal skin. The growth of pubic hair and pigmented hair on the legs, arms, and chest takes place during this period. The enlargement of the larynx, containing the vocal cords, which leads to a deepening of the voice causes much stress for a pubescent boy. In this transitional period in his voice tends to "crack." Cognitive Development: Current views on the mental changes that take place during adolescence have been affected heavily by the work of the Swiss psychologist Jean Piaget, who sees the intellectual capability of adolescents as both "qualitatively and quantitatively superior to that of younger children." According to Piaget and the developmentalist school of psychology, the thinking capacity of young people automatically increases in complexity as a function of age. Developmentalists find distinct differences between younger and older adolescents in ability to generalize, to handle abstract ideas, to infer appropriate connections between cause and effect, and to reason logically and consistently. Whether these changes in cognitive ability are a result of the developmental stage, as Piaget suggests, or should be considered the result of accumulating knowledge that allows for new mental and moral perspectives, an enlarged capacity for making distinctions, and a greater awareness of and sensitivity to others, is a question that psychologists continually debate. Behaviorists such as Harvard's B. F. Skinner did not believe intellectual development could be divided into distinct stages. He preferred to emphasize the influence of conditioning experiences on behavior as a result of continuous punishments and rewards. Trying to prove that intellectual ability in adolescence differs from that of earlier years, as a result of learning, or acquiring more appropriate responses through conditioning. Other investigators have found a strong tie between certain socioeconomic characteristics and adolescent intellectual achievement. Statistics suggest that well-educated, economically secure, small-sized families provide the kind of environment which intellectual development among adolescents is most apt to flourish. This environment should also include parental encouragement, individual attention, and an extended vocabulary use. Test scores, however, seem to be more related to the verbal ability than to the performance aspects of adolescents' intelligence. Identity Formation: Psychologists also disagree about the causes and significance of the emotional and personality changes that occur during adolescence. Many Freudian psychologists believe that the straightforward sexual awakening of adolescents is an inevitable cause of emotional strain. This strain sometimes leads to neurosis. Psychologists who have different beliefs place less emphasis on the specific sexual aspects of adolescence. These physiologists consider sex as only one of many adjustments young people must make in their search for an identity. The effects of physical change, the development of sexual impulses, increased intellectual capacity, and social pressure to achieve independence are all contributor to the molding of a new self. The components of identity formation are connected to the adolescent's self-image. This means adolescents are greatly affected by the opinions of people who are important in their lives and interact with them. Gradually, the emotional dependency of childhood transforms into an emotional commitment to meet the expectations of others. An adolescent seeks to please parents, peers, teachers, employers and so on. If adolescents fail to meet the goals set for them by the important people in their lives, they usually feel like they have to reevaluate their motives, attitudes, or activities. The approval that seems necessary at this stage can help determine both their later commitment to responsible behavior and their sense of social competence throughout life. The peer group of an adolescent also provide a standard in which they can measure themselves during the process of identity formation. Within the peer group, a young person can try out a variety of roles. Whether taking the role of a leader or follower, deviant or conformist, the values and norms of the group allow them to acquire a perspective of their own. A peer group can also help with the transition from reliance on the family to relative independence. There is a common language amongst adolescents, whether it is clothing, music, or gossip, these forms of expression allow them to display their identity. This new form of association helps to ease the anxiety of leaving their past source of reference to their identity. Parent-Adolescent Relations: The family has traditionally provided a set of values for young people to observe. Through this observation they can begin to learn adult ways of behavior. In modern industrial societies the nuclear family has come to be relatively unstable, for divorce is growing increasingly common and many children reach adolescence with only one parent. In addition, rapid social changes have weakened the smoothens of life experience. Adolescents a greater difference between the parental-child generations then their parent did. They tend to view their parents as having little capacity to guide them in their transition from their world to the larger world. The conflict that sometimes results from differing parent-adolescent perceptions is called the "generation gap." Such conflicts are not inevitable, for it is less likely to happen in families in which both adolescents and parents have been exposed to the same new ideas and values. Other parental characteristics that commonly influence adolescents include social class, the pattern of equality or dominance between mother and father, and the consistency with which parental control is exercised. Young people with parents whose guidance is firm, consistent, and rational tend to possess greater self-confidence than those whose parents are either overly tolerant or strict. Adolescence In Modern Society: Adolescence is often looked upon as a period of stormy and stressful transition. Anthropologists have noted that in less developed cultures the adolescent years do not always have to exhibit such characteristics, when children can participate fully in the activities of their community. As life in industrialized societies grows more complex, however, adolescents are increasingly cut off from the activities of their elders, leaving most young people with education as their sole occupation. Inevitably, this has isolated many of them from the adult world and has prolonged their adolescence. In advanced industrial societies such as the United States, the adolescent years have become marked by violence to an alarming degree. The phenomenon of teenage suicide has become particularly disturbing, but risk-taking behaviors of many sorts can be observed, including alcohol and drug abuse. Bibliography: Conger, John J., Adolescence: Generation under Pressure (1980) Dacey, J. E., Adolescents Today, 3d ed. (1986) Fuhrman, B. S., Adolescence, Adolescents (1986) Hauser, Stuart T., et al., Adolescents and Their Families (1991) Santrock, J. W., Adolescence: An Introduction, 3d ed. (1987) Sprinthall, Norman, and Collins, W. A., Development in Adolescence, 2d ed. (1985). Table Of Contents Introduction.............................................Page: 1 Physiological Changes............................Page: 1-2 Cognitive Development........................Page: 3-4 Identity Formation..................................Page: 4-5 Parent-Adolescent Relations.................Page: 5-6 Adolescence Today..................................Page: 6 Bibliography..............................................Page: 7 Adolescence f:\12000 essays\health & humanities (196)\Aha!.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Aha! Have you ever been trying to figure something out that you just can't piece together and then all of a sudden have it hit you? If you have, you've experienced the type of learning called insight learning. The term insight refers to solving a problem through understanding the relationships various parts of a problem. Wolfgang Kohler, a Gestalt psychologist who was born in 1887 and died in 1967, used chimpanzees in the study of insight learning. Kohler who was born in Revel, Estonia and moved to the United States in 1935, did pioneering studies in the behavior of apes that showed the importance of perceptual organization and insight in learning. His groundbreaking experiment involved one of his chimpanzees, Sultan. Sultan had learned to use a stick to rake in bananas outside of his cage. This time Kohler placed the banana outside of the reach of just one stick and gave Sultan two sticks that could be fitted together to make a single pole that was long enough to reach the banana. After fiddling with the sticks for an hour or so, Sultan happened to align the sticks and in a flash of sudden inspiration, fitted the two sticks together and pulled in the banana. Kohler was impressed by Sultan's rapid "perception of relationships" and used the term insight to describe it. He noted that such insights are not learned gradually through reinforced trials. They seemed to occur in a flash when the elements a problem are set up appropriately. In another experiment boxes were put in a room with a banana hanging from the ceiling. The chimps found out that they could stack the boxes on top of one another to reach the banana without being taught to do it. It was also found that rats made cognitive maps, which are mental representations or "pictures" of the elements in a learning situation, of the mazes that they were going through. Not surprisingly, the rats learned the way quicker on a route in which reinforcement was available. I guess that just goes to show you that when you're interested in something, you will of retain the information better and understand it too. Here is a personal example of insight learning. One day I was playing a game called The Seventh Guest was on my computer. It is a game with lots of mind bending puzzles that can be very difficult. There was this on particular puzzle I had been working on for hours and just couldn't solve it, then all of a sudden the answer hit me and I almost kicked myself when I figured out how simple it was. This kind of thing happens to me all the time and I'm sure everyone can think of at least one time when an answer to a problem just hit them. It is difficult to explain these types of behavior in terms of conditioning. It seems that we suddenly percieve the relationships between the elements of our problems so that the solution occurs by insight. We seem to have what Gestalt psychologists call the "Aha! experience." f:\12000 essays\health & humanities (196)\AIDS 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The HIV virus poses one of the biggest viral threats to human society today. It is contracted through bodily fluids such as blood and semen, and sometimes even saliva and tears. AIDS kills 100% of its victims and puts them through agony before they die. It has been a threat for about 15 years, and it is not going to stop now. In fact, AIDS is just getting started: It consumes more people each year. There is no known treatment for it either, only antibiotics to slow the reproduction of the virus. HIV is passed from one person to another by bodily fluids only. It is usually gotten through sexual intercourse or other intimate contact, through the exchanging of unsterilized intravenous needles, or by the contact of HIV-infected bodily fluids and an open wound. It cannot permeate though intact skin, hence it cannot be spread through informal contact. AIDS has not been found to travel in insects or tame animals. In pregnant women, the virus only infects the infant near or at the time of birth. The virus dies quickly without a host. AIDS (Acquired ImmunoDifficiency Syndrome) weakens the body¹s immune system so it is sensitive to infection. The AIDS virus primarily attacks the T lymphocytes, which are a main part of the immune system. The virus is also incubated in cells called macrophages, where it is accidentally sent to other, healthy cells in the body like neurons and lymphatic cells. After HIV is contracted, the person looks and feels healthy for up to 20 years before symptoms start occurring. During this time, the person can give the virus to another even though it cannot be detected by sight or smell. Usually, symptoms start developing within 1 to 2 years. Typical indications of the virus are fever, weariness, weight loss, skin rashes, a fungal mouth infection called thrush, lack of immunity to infection, and enlarged lymph nodes. When AIDS overtakes the body, the body becomes especially susceptible to tuberculosis, pneumonia, and a rare form of cancer called Kaposi¹s Sarcoma. Once AIDS has fully taken hold, the body may suffer damage to the nerves and brain. The life expectancy of an AIDS victim after the birth of symptoms is 1 to 5 years. AIDS was believed to have begun in Central Africa around 1979. Nearly all of the first AIDS patients were male homosexuals. However, after 1989 90% of all new cases of AIDS were from heterosexual intercourse. Public awareness rose as famous people began to die, like Rock Hudson, Perry Ellis, Michael Bennett, Robert Mapplethorpe, and Tony Richardson. Basketball star Magic Johnson also reported having AIDS. The approximate number of AIDS cases in the U.S. alone is 65,000 and growing. So far, there is no treatment or vaccination for AIDS. With most viruses, the body produces antibodies that eventually destroy the virus. However, with HIV, natural antibodies are completely ineffective. Blood tests will not give accurate results of infection of HIV until between 2 weeks and 3 months after the initial infection. In 1987, the drug AZT (azidothymidine) had proved effective in slowing the growth of the virus, but it was lethal in large doses and some patients could not handle taking it at all. There was a new HIV-fighting chemical scientists found called DDI (dideoxyinosine) that was not as harmful to the patient and could be used in AZT¹s place for more sensitive patients. In 1992 DDC (zalcitbine) was found to be useful for delaying the reproduction of HIV in patients with advanced AIDS, but only in conjunction with AZT. AIDS is one of an epidemic of super-deadly viruses like Ebola, Hanta Virus, and Dingae in Puerto Rico. In my opinion, this is nature¹s way of fighting back from overpopulation. However, AIDS is a formidable disease and is a force to be reckoned with. f:\12000 essays\health & humanities (196)\AIDS 3.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AIDS: A U.S.- Made Monster? PREFACE In an extensive article in the Summer-Autumn 1990 issue of "Top Secret", Prof J. Segal and Dr. L. Segal outline their theory that AIDS is a man-made disease, originating at Pentagon bacteriological warfare labs at Fort Detrick, Maryland. "Top Secret" is the international edition of the German magazine Geheim and is considered by many to be a sister publication to the American Covert Action Information Bulletin (CAIB). In fact, Top Secret carries the Naming Names column, which CAIB is prevented from doing by the American government, and which names CIA agents in different locations in the world. The article, named "AIDS: US-Made Monster" and subtitled "AIDS - its Nature and its Origins," is lengthy, has a lot of professional terminology and is dotted with footnotes. AIDS FACTS "The fatal weakening of the immune system which has given AIDS its name (Acquired Immuno-Deficiency Syndrome)," write the Segals, "has been traced back to a destruction or a functional failure of the T4-lymphocytes, also called 'helper cells`, which play a regulatory role in the production of antibodies in the immune system." In the course of the illness, the number of functional T4- cells is reduced greatly so that new anti-bodies cannot be produced and the defenceless patient remains exposed to a range of infections that under other circumstances would have been harmless. Most AIDS patients die from opportunistic infections rather than from the AIDS virus itself. The initial infection is characterized by diarrhea, erysipelas and intermittent fever. An apparent recovery follows after 2-3 weeks, and in many cases the patient remains without symptoms and functions normally for years. Occasionally a swelling of the lymph glands, which does not affect the patient's well-being, can be observed. After several years, the pre-AIDS stage, known as ARC (Aids- Related Complex) sets in. This stage includes disorders in the digestive tract, kidneys and lungs. In most cases it develops into full-blown AIDS in about a year, at which point opportunistic illnesses occur. Parallel to this syndrome, disorders in various organ systems occur, the most severe in the brain, the symptoms of which range from motoric disorders to severe dementia and death. This set of symptoms, say the Segals, is identical in every detail with the Visna sickness which occurs in sheep, mainly in Iceland. (Visna means tiredness in Icelandic). However, the visna virus is not pathogenic for human beings. The Segals note that despite the fact that AIDS is transmitted only through sexual intercourse, blood transfusions and non- sterile hypodermic needles, the infection has spread dramatically. During the first few years after its discovery, the number of AIDS patients doubled every six months, and is still doubling every 12 months now though numerous measures have been taken against it. Based on these figures, it is estimated that in the US, which had 120,000 cases of AIDS at the end of 1988, 900,000 people will have AIDS or will have died of it by the end of 1991. It is also estimated that the number of people infected is at least ten times the number of those suffering from an acute case of AIDS. That in the year 1995 there will be between 10-14 million cases of AIDS and an additional 100 million people infected, 80 percent of them in the US, while a possible vaccination will not be available before 1995 by the most optimistic estimates. Even when such vaccination becomes available, it will not help those already infected. These and following figures have been reached at by several different mainstream sources, such as the US Surgeon General and the Chief of the medical services of the US Army. "AIDS does not merely bring certain dangers with it; it is clearly a programmed catastrophe for the human race, whose magnitude is comparable only with that of a nuclear war", say the Segals. " They later explain what they mean by "programmed," showing that the virus was produced by humans, namely Dr. Robert Gallo of the Bethesda Cancer Research Center in Maryland. When proceeding to prove their claims, the Segals are careful to note that: "We have given preference to the investigative results of highly renowned laboratories, whose objective contents cannot be doubted. We must emphasize, in this connection, that we do not know of any findings that have been published in professional journals that contradict our hypotheses." DISCOVERING AIDS The first KNOWN cases of AIDS occurred in New York in 1979. The first DESCRIBED cases were in California in 1979. The virus was isolated in Paris in May 1983, taken from a French homosexual who had returned home ill from a trip to the East Coast of the US. One year later, Robert Gallo and his co-workers at the Bethesda Cancer Research Center published their discovery of the same virus, which is cytotoxic. ( i.e poisonous to cells ) Shortly after publishing his discovery, Gallo stated to newspapers that the virus had developed by a natural process from the Human Adult Leukemia virus, HTLV-1, which he had previously discovered. However, this claim was not published in professional publications, and soon after, Alizon and Montagnier, two researchers of the Pasteur Institute in Paris published charts of HTLV-1 and HIV, showing that the viruses had basically different structures. They also declared categorically that they knew of no natural process by which one of these two forms could have evolved into the other. According to the professional "science" magazine, the fall 1984 annual meeting of the American Association for the Advancement of Science (AAAS), was almost entirely devoted to the question of: to what extent new pathogenic agents could be produced via human manipulation of genes. According to the Segals, AIDS was practically the sole topic of discussion. THE AIDS VIRUS The Segals discuss the findings of Gonda et al, who compared the HIV, visna and other closely-related viruses and found that the visna virus is the most similar to HIV. The two were, in fact, 60% identical in 1986. According to findings of the Hahn group, the mutation rate of the HIV virus was about a million times higher than that of similar viruses, and that on the average a 10% alteration took place every two years. That would mean that in 1984, the difference between HIV and visna would have been only 30%, in 1982- 20%, 10% in 1980 and zero in 1978. "This means," say the Segals, "that at this time visna viruses changed into HIV, receiving at the same time the ability to become parasites in human T4-cells and the high genetic instability that is not known in other retroviruses. This is also consistent with the fact that the first cases of AIDS appeared about one year later, in the spring of 1979." "In his comparison of the genomes of visna and HIV," add the Segals, "Coffin hit upon a remarkable feature. The env (envelope) area of the HIV genome, which encodes the envelope proteins which help the virus to attach itself to the host cell, is about 300 nucleotides longer than the same area in visna. This behaviour suggests that an additional piece has been inserted into the genomes of the visna virus, a piece that alters the envelope proteins and enables them to bind themselves to the T4-receptors. BUT THIS SECTION BEHAVES LIKE A BIOLOGICALLY ALIEN BODY, which does not match the rest of the system biochemically. The above mentioned work by Gonda et al shows that the HIV virus has a section of about 300 nucleotides, which does not exist in the visna virus. That length corresponds with what Coffin described. That section is particularly unstable, which indicates that it is an alien object. According to the Segals, it "originates in an HTLV-1 genome, (discovered by Gallo-ED) for the likelihood of an accidental occurrence in HIV of a genome sequence 60% identical with a section of the HTLV-1 that is 300 nucleotides in length is zero." Since the visna virus is incapable of attaching itself to human T4 receptors, it must have been the transfer of the HTLV-1 genome section which gave visna the capability to do so. In other words, the addition of HTLV-1 to visna made the HIV virus. In addition, the high mutation rate of the HIV genome has been explained by another scientific team, Chandra et al, by the fact that it is "a combination of two genome parts which are alien to each other BY ARTIFICIAL MEANS rather than by a natural process of evolution, because this process would have immediately eliminated, through natural selection, systems that are f:\12000 essays\health & humanities (196)\AIDS 4.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Engl. 118 April 14, 1996 I. Introduction Thesis- Practicing safe sex is essential in a world where diseases like AIDS exist. II. Body a. There are many forms of safe sex, abstinence being the only 100% effective one. 1. If one chooses to have sex then condom use is very important. 2. The faults of condoms. 3. There is no type of sex that is safe b. Many say that the idea of safe sex is a myth c. There is a lack of education, about AIDS, especially in teenagers. 1. Is it really worth teaching? Are they going to listen? a. how should it be taught 2. Abstinence should be taught more often than safe sex. 3. different teaching techniques, such as teaching at an early age and teaching free of moralistic discussion. 4. The use of condoms. D. What are some reasons for not using condoms in today's world? 1. It's not AIDS and other STD's are not talked about enough 2. Personal reasons for not using them. E. If one practices safe sex then their chances of getting a disease are lessened dramatically. 1. Facts and figures 2. chances of getting AIDS III. Conclusion The fastest growing numbers of AIDS cases are now in teenagers and young adults; education is the key in influencing these young people not to contribute to the numbers f:\12000 essays\health & humanities (196)\AIDS 5.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The United Nations AIDS organization released disturbing estimates Thursday of the seemingly relentless expansion of the HIV pandemic. At a time when many Americans are increasingly optimistic that state-of-the-art drug therapy might eliminate the virus, HIV is taking a heavy toll worldwide. According to the agency, every minute of every day somewhere in the world, six people become infected with HIV: 7,500 adults per day and 1,000 children. About 30 million people have acquired the virus during the last 15 years; 6.4 million of them have died of AIDS. Behind this mounting death count are the signs of growing social disruption. For example, in sub-Saharan Africa, more than 1 million children have lost their parents to AIDS. And within four years, there will be more than 2 million AIDS orphans in the following seven countries combined: Dominican Republic, Kenya, Rwanda, Thailand, Uganda, the United States, and Zambia. Illness and death among young adults due to HIV have reached such proportions in some countries that overall national economics and productivity are affected. In Uganda, for example, 44 percent of all premature deaths are attributable to AIDS. In terms of years of labor productivity, AIDS is responsible for more than 66 percent of Uganda's economically significant losses. The virus is also spreading into new areas. For example: -During the last three years, HIV-infection rates among Vietnamese prostitutes jumped from 9 percent to 38 percent. -Infection rates among blood donors in the Cambodian capital of Phnom Penh have soared from 0.1 percent to more than 10 percent. -In the Ukrainian Black Sea port of Nikolayev, HIV-infection rates among narcotics users exploded in 1995, jumping from a 1.7 percent in January to 56.5 percent in November. -South Africa, long spared, is now being overrun. Tests of pregnant women in the province of Kwazulu/Natal show a jump from 9.6 percent to 18 percent. In my opinion, I think that all the scientists of the world should get together and try to devise a cure for HIV and AIDS. It may take time, and it may take money; but I think it is worth it in order to save mankind from extinction and total annihilation. f:\12000 essays\health & humanities (196)\AIDS 6.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AIDS AIDS(Acquired Immune Deficiency Syndrome) is a deadly disease for which there is no cure. This disease was first recognized in the mid 1980's. The cause of AIDS is the HIV virus, and is most commonly spread by venereal routes or exposure to contaminated blood or blood products. This disease weakens the body's immune system, allowing other diseases to occur. The most common treatments available for this virus are the drugs called AZT, DDI, and DDC which interfere with HIV'S ability to reproduce itself. These are the only known ways to slow down the production of the virus. This virus is spread through the exchange of body fluids {semen, blood, and blood products} this virus can stay in the body for as long as a decade with no symptoms. People who have AIDS have to go through a lot of complications and anxiety.The most common anxiety is that they have to go through their life knowing that they are going to die from this disease, another is the pain and suffering they know they will have to go through. The difference between HIV and AIDS is that HIV is the virus that causes AIDS, and AIDS is a disease of the immune system and unfortunately at this time there is no cure for. f:\12000 essays\health & humanities (196)\Aids 7.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ FACTS ON AIDS Cases of AIDS have been reported in 85 countries. It is estimated between 5 and 10 million people around the world now carry the AIDS virus and that as many as 100 million will become infected over the next 10 years. How can you become infected? 1. sexual intercourse a) vaginal Having another sexually transmitted disease such as syphilis, b) anal herpes or gonorrhea appears to make someone more c) oral susceptible to acquiring HIV infection during sex with an infected partner 2. blood transfusions - since November 1985 in Canada all blood and blood products are tested for HIV antibodies 3. infection drug users by sharing needles or syringes with someone already infected 4. during pregnancy, at birth or through breast feeding, an infected mother can pall the virus to her child How you cannot become infected: 1. sitting next to someone 2. touching or shaking hands 3. eating in a restaurant 4. sharing food, plates, cups or utensils 5. using bathrooms, water coolers, or telephones 6. swimming in a pool or using a hot tub 7. donating blood 8. being bitten by mosquitoes or any other insects Symptoms: Symptoms may not show for 10 years after you become infected by the HIV virus. A month or two after exposure to the virus there may be flu-like symptoms that may last a week to a month and is often mistaken for those of another viral infections. More persistent or severe symptoms that may not surface for a decade or more: - swollen lymph glands - recurrent fever, including "night sweats" - rapid weight loss for no apparent reason - constant fatigue - diarrhea and diminished appetite - white spots or unusual blemishes in the mouth Prevention: 1. abstain for sex 2.have protected sex with latex condoms whenever having anal, oral or vaginal sex 3. limit number of partners 4. do not share needles It is important to educate children for many reasons: 1. to reduce their fears about disease 2. to help delay the beginning of sexual activity 3. to encourage the use of condoms and safer sex practices if children are already sexually active There are many different aids you can use to help teach the children the facts on AIDS: - videos - games - guest speakers - quizzes - papers - presentations - question and answer periods For more information as a future teacher contact: - your local health unit or community health center - your local AIDS organization - AIDS hotlines - your doctor - your family planning clinic - library Be creative when educating children on AIDS. They love to learn about topics such as this if you put enjoyment in the learning process. An example of a game you can play that the children really enjoy is the teacher reading out questions, multiple choice, true and false etc. and the children responding by putting up their hand, the first hand the teacher sees raised can answer the question and if it is correct they are awarded with a prize ( a candy for example). You could divide the class up into teams to make it a fun competitive game. You can play many different games such as this that the children enjoy, and are learning at the same time, BE CREATIVE!! f:\12000 essays\health & humanities (196)\Aids a U S made monster.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AIDS: A U.S.- Made Monster? PREFACE In an extensive article in the Summer-Autumn 1990 issue of "Top Secret", Prof J. Segal and Dr. L. Segal outline their theory that AIDS is a man-made disease, originating at Pentagon bacteriological warfare labs at Fort Detrick, Maryland. "Top Secret" is the international edition of the German magazine Geheim and is considered by many to be a sister publication to the American Covert Action Information Bulletin (CAIB). In fact, Top Secret carries the Naming Names column, which CAIB is prevented from doing by the American government, and which names CIA agents in different locations in the world. The article, named "AIDS: US-Made Monster" and subtitled "AIDS - its Nature and its Origins," is lengthy, has a lot of professional terminology and is dotted with footnotes. AIDS FACTS "The fatal weakening of the immune system which has given AIDS its name (Acquired Immuno-Deficiency Syndrome)," write the Segals, "has been traced back to a destruction or a functional failure of the T4-lymphocytes, also called 'helper cells`, which play a regulatory role in the production of antibodies in the immune system." In the course of the illness, the number of functional T4- cells is reduced greatly so that new anti-bodies cannot be produced and the defenceless patient remains exposed to a range of infections that under other circumstances would have been harmless. Most AIDS patients die from opportunistic infections rather than from the AIDS virus itself. The initial infection is characterized by diarrhea, erysipelas and intermittent fever. An apparent recovery follows after 2-3 weeks, and in many cases the patient remains without symptoms and functions normally for years. Occasionally a swelling of the lymph glands, which does not affect the patient's well-being, can be observed. After several years, the pre-AIDS stage, known as ARC (Aids- Related Complex) sets in. This stage includes disorders in the digestive tract, kidneys and lungs. In most cases it develops into full-blown AIDS in about a year, at which point opportunistic illnesses occur. Parallel to this syndrome, disorders in various organ systems occur, the most severe in the brain, the symptoms of which range from motoric disorders to severe dementia and death. This set of symptoms, say the Segals, is identical in every detail with the Visna sickness which occurs in sheep, mainly in Iceland. (Visna means tiredness in Icelandic). However, the visna virus is not pathogenic for human beings. The Segals note that despite the fact that AIDS is transmitted only through sexual intercourse, blood transfusions and non- sterile hypodermic needles, the infection has spread dramatically. During the first few years after its discovery, the number of AIDS patients doubled every six months, and is still doubling every 12 months now though numerous measures have been taken against it. Based on these figures, it is estimated that in the US, which had 120,000 cases of AIDS at the end of 1988, 900,000 people will have AIDS or will have died of it by the end of 1991. It is also estimated that the number of people infected is at least ten times the number of those suffering from an acute case of AIDS. That in the year 1995 there will be between 10-14 million cases of AIDS and an additional 100 million people infected, 80 percent of them in the US, while a possible vaccination will not be available before 1995 by the most optimistic estimates. Even when such vaccination becomes available, it will not help those already infected. These and following figures have been reached at by several different mainstream sources, such as the US Surgeon General and the Chief of the medical services of the US Army. "AIDS does not merely bring certain dangers with it; it is clearly a programmed catastrophe for the human race, whose magnitude is comparable only with that of a nuclear war", say the Segals. " They later explain what they mean by "programmed," showing that the virus was produced by humans, namely Dr. Robert Gallo of the Bethesda Cancer Research Center in Maryland. When proceeding to prove their claims, the Segals are careful to note that: "We have given preference to the investigative results of highly renowned laboratories, whose objective contents cannot be doubted. We must emphasize, in this connection, that we do not know of any findings that have been published in professional journals that contradict our hypotheses." DISCOVERING AIDS The first KNOWN cases of AIDS occurred in New York in 1979. The first DESCRIBED cases were in California in 1979. The virus was isolated in Paris in May 1983, taken from a French homosexual who had returned home ill from a trip to the East Coast of the US. One year later, Robert Gallo and his co-workers at the Bethesda Cancer Research Center published their discovery of the same virus, which is cytotoxic. ( i.e poisonous to cells ) Shortly after publishing his discovery, Gallo stated to newspapers that the virus had developed by a natural process from the Human Adult Leukemia virus, HTLV-1, which he had previously discovered. However, this claim was not published in professional publications, and soon after, Alizon and Montagnier, two researchers of the Pasteur Institute in Paris published charts of HTLV-1 and HIV, showing that the viruses had basically different structures. They also declared categorically that they knew of no natural process by which one of these two forms could have evolved into the other. According to the professional "science" magazine, the fall 1984 annual meeting of the American Association for the Advancement of Science (AAAS), was almost entirely devoted to the question of: to what extent new pathogenic agents could be produced via human manipulation of genes. According to the Segals, AIDS was practically the sole topic of discussion. THE AIDS VIRUS The Segals discuss the findings of Gonda et al, who compared the HIV, visna and other closely-related viruses and found that the visna virus is the most similar to HIV. The two were, in fact, 60% identical in 1986. According to findings of the Hahn group, the mutation rate of the HIV virus was about a million times higher than that of similar viruses, and that on the average a 10% alteration took place every two years. That would mean that in 1984, the difference between HIV and visna would have been only 30%, in 1982- 20%, 10% in 1980 and zero in 1978. "This means," say the Segals, "that at this time visna viruses changed into HIV, receiving at the same time the ability to become parasites in human T4-cells and the high genetic instability that is not known in other retroviruses. This is also consistent with the fact that the first cases of AIDS appeared about one year later, in the spring of 1979." "In his comparison of the genomes of visna and HIV," add the Segals, "Coffin hit upon a remarkable feature. The env (envelope) area of the HIV genome, which encodes the envelope proteins which help the virus to attach itself to the host cell, is about 300 nucleotides longer than the same area in visna. This behaviour suggests that an additional piece has been inserted into the genomes of the visna virus, a piece that alters the envelope proteins and enables them to bind themselves to the T4-receptors. BUT THIS SECTION BEHAVES LIKE A BIOLOGICALLY ALIEN BODY, which does not match the rest of the system biochemically. The above mentioned work by Gonda et al shows that the HIV virus has a section of about 300 nucleotides, which does not exist in the visna virus. That length corresponds with what Coffin described. That section is particularly unstable, which indicates that it is an alien object. According to the Segals, it "originates in an HTLV-1 genome, (discovered by Gallo-ED) for the likelihood of an accidental occurrence in HIV of a genome sequence 60% identical with a section of the HTLV-1 that is 300 nucleotides in length is zero." Since the visna virus is incapable of attaching itself to human T4 receptors, it must have been the transfer of the HTLV-1 genome section which gave visna the capability to do so. In other words, the addition of HTLV-1 to visna made the HIV virus. In addition, the high mutation rate of the HIV genome has been explained by another scientific team, Chandra et al, by the fact that it is "a combination of two genome parts which are alien to each other BY ARTIFICIAL MEANS rather than by a natural process of evolution, because this process would have immediately eliminated, through natural selection, systems that are so replete with disorders." "These are the facts of the case," say the Segals. "HIV is essentially a visna virus which carries an additional protein monomer of HTLV-1 that has an epitope capable of bonding with T4 receptors. Neither Alizon and Montagnier nor any other biologist know of any natural mechanism that would make it possible for the epitope to be transferred from HTLV-1 to the visna virus. For this reason we can come to only one conclusion: that this gene combination arose by artificial means, through gene manipulation." THE CONSTRUCTION OF HIV "The construction of a recombinant virus by means of gene manipulation is extraordinarily expensive, and it requires a large number of highly qualified personnel, complicated equipment and expensive high security laboratories. Moreover, the product would have no commercial value. Who, then," ask the Segals, "would have provided the resources for a type of research that was aimed solely at the production of a new disease that would be deadly to human beings?" The English sociologist Allistair Hay (as well as Paxman et al in "A Higher Form of Killing"-ED), published a document whose authenticity has been confirmed by the US Congress, showing that a representative of the Pentagon requested in 1969 additional funding for biological warfare research. The intention was to create, within the next ten years, a new virus that would not be susceptible to the immune system, so that the afflicted patient would not be able to develop any defense against it. Ten years later, in the spring of 1979, the first cases of AIDS appeared in New York. "Thus began a phase of frantic experimentation," say the Segals. One group was working on trying to cause animal pathogens to adapt themselves to life in human beings. This was done under the cover of searching for a cure for cancer. The race was won by Gallo, who described his findings in 1975. A year later, Gallo described gene manipulations he was conducting. In 1980 he published his discovery of HTLV. In the fall of 1977, a P4 (highest security category of laboratory, in which human pathogens are subjected to genetic manipulations) laboratory was officially opened in building 550 of Fort Detrick, MD, the Pentagon's main biological warfare research center. "In an article in 'Der Spiegel`, Prof. Mollings point out that this type of gene manipulation was still extremely difficult in 1977. One would have had to have a genius as great as Robert Gallo for this purpose, note the Segals." Lo and behold. In a supposed compliance with the international accord banning the research, production and storage of biological weapons, part of Fort Detrick was "demilitarized" and the virus section renamed the "Frederick Cancer Research Facility". It was put under the direction of the Cancer Research Institute in neighbouring Bethesda, whose director was no other than Robert Gallo. This happened in 1975, the year Gallo discovered HTLV. Explaining how the virus escaped, the Segals note that in the US, biological agents are traditionally tested on prisoners who are incarcerated for long periods, and who are promised freedom if they survive the test. However, the initial HIV infection symptoms are mild and followed by a seemingly healthy patient. "Those who conducted the research must have concluded that the new virus was...not so virulent that it could be considered for military use, and the test patients, who had seemingly recovered, were given their freedom. Most of the patients were professional criminals and New York City, which is relatively close, offered them a suitable milieu. Moreover, the patients were exclusively men, many of them having a history of homosexuality and drug abuse, as is often the case in American prisons. It is understandable why AIDS broke out precisely in 1979, precisely among men and among drug users, and precisely in New York City," assert the Segals. They go on to explain that whereas in cases of infection by means of sexual contact, incubation periods are two years and more, while in cases of massive infection via blood transfusions, as must have been the case with prisoners, incubation periods are shorter than a year. "Thus, if the new virus was ready at the beginning of 1978 and if the experiments began without too much delay, then the first cases of full-blown AIDS in 1979 were exactly the resultthat could have been expected." In the next three lengthy chapters, the Segals examine other theories, "legends" as they call them, of the origins of AIDS. Dissecting each claim, they show that they have no scientific standing, providing also the findings of other scientists. They also bring up the arguments of scientists and popular writers who have been at the task of discounting them as "conspiracy theorists" and show these writers' shortcomings. Interested readers will have to read the original article to follow those debates. I will only quote two more paragraphs: "We often heard the argument that experiments with human volunteers are part of a barbaric past, and that they would be impossible in the US today... We wish to present one single document whose authenticity is beyond doubt. An investigative commission of the US House of Representatives presented in October 1986 a final report concerning the Manhattan Project. According to this document, between 1945 and 1975 at least 695 American citizens were exposed to dangerous doses of radioactivity. Some of them were prisoners who had volunteered, but they also included residents of old-age homes, inmates of insane asylums, handicapped people in nursing homes, and even normal patients in public hospitals; most of them were subjected to these experiments without their permission. Thus the 'barbaric past` is not really a thing of the past." "It is remarkable that most of these experiments were carried out in university institutes and federal hospitals, all of which are named in the report. Nonetheless, these facts remained secret until 1984, and even then a Congressional committee that was equipped with all the necessary authorization needed two years in order to bring these facts to life. We are often asked how the work on the AIDS virus could have been kept secret. Now, experiments performed on a few dozen prisoners in a laboratory that is subject to military security can be far more easily kept secret than could be the Manhattan Project." f:\12000 essays\health & humanities (196)\aids discrimination 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ -TheEducationofA.I.D.SDiscrimination  Employees are being discriminated against for theirinfectious illness known as A.I.D.S. They are labeledincapable of performing the tasks they pursued before theywere recognized as being infected. The confidentiality of anemployee is a private matter and very personal. There aremany different kinds of prejudice but not one as deadly asA.I.D.S Discrimination. The emotional trauma and future ofemployment play a giant role in the inflicted. HealthPolicies through job-related fields must learn to recognizethat like other illnesses, A.I.D.S does not forbid anemployee of performing his or her duties. It is the mostaltering form of discrimination because of the fact thatevery time a person finds out they are positive, theopinions of those who surround them are likely to change. The working class is the most susceptible to this form ofdiscrimination. The every day environment of an employeewith A.I.D.S is also the work grounds for someone who isn'tinfected with A.I.D.S. A.I.D.S Discrimination in ajob-related atmosphere is due to lack of education andsensitivity.  The infection of HIV does not reduce an employee'sefficiency from satisfactory to intolerable. An employeeshould not be denied employment or promotion if they are not flawed by HIV. Some employees are not stripped of theircapacities to perform even though they are infected with HIV(Lewy 2). Why should the employee health benefits be alteredbecause of the nature of the disease. The majority ofemployee policies offered cover catastrophic illness withonly ten percent covering A.I.D.S. One particular policystates that people do not become infected through usualbehavior in a working environment. This illustrates thatA.I.D.S patients are protected under disability law and areentitled to the same medical benefits (Karr A1). Policiesmust be issued to protect the inflicted. A Department ofHealth and Human Services review board has ruled"discrimination against someone who's HIV-positive isillegal" (Kolasa 63). Where does it say that unless theinfected is under employment? The main thing to understandis that it doesn't. Eileen Kolasa reminds us of a law ofdirect meaning "HIV is a handicap protected under federallaw" (66). The American justice system is what decides thefate of the infected. The challenge of bringing an A.I.D.Sdiscrimination case in court has become very common in theUnited States. Such actions have been victorious and havehelped pass revised Disability Acts which applies to alldiseases (Annas 592).  Even though the infected are defended under law, itstill violates a person's human rights of personal healthsecrecy. This discrimination has not received attention as aform of human-rights violation. The government and courtsystems have helped essentially, but discrimination alsoaffects medical care. Physicians and lawyers should promote the interests of the sick as well (Annas 592). Revealingthis condition is a serious decision to make. Thepossibilities of acceptance will differ in the lives of manyHIV-positive employees. Helen Lippman, senior editor of RNmagazine replies: If legislation were passed requiring health-care providers to report their HIV status, nearly  four in ten respondents say that they would report a suspected violation. (32) The tutelage of A.I.D.S at a job can considerably changeattitudes of credibility. The Americans With Disability Actgoverns to any company with twenty-five or more employees. This legislation forbids discrimination against anydisability or chronic disease. The interesting fine print isthat it specifically mentions A.I.D.S. within its text(Pogash 77). The policies do mot automatically make theroutines of companies more likely to accept them. Wyatt JohnBunker explains from Karrs article "the gold standard isn'twhether companies have a policy, but how they handle A.I.D.S.on a day to day basis" (A1). One of the first A.I.D.S. discrimination cases that wasfiled was against United Airlines. Two pilots wereprohibited from flying due to the fact that they wereHIV-positive. James F. Peltz and Stuart Silverstein, LosAngeles Times writers, explain that "the case extends thealready-sensitive subject of A.I.D.S. in the workplace toanother group of professionals whose jobs include protectingthe safety of others" (D1). Bunker's theory does make sensein the employee situations where the general public becomes a dynamic participant in the matter. Robert Lewy shares hisview of determining if an employee is able to perform his orher obligation of employment by a series of guidelines: HIV-infected workers should be treated the same  as persons with any other non-work-related injuries or illnesses, such as diabetes or epilepsy. They are entited to equal rights and benefits of employment, including  available medical services. (9)  -----One possible solution is to educate the businesses to besympathetic. The Centers for Disease Control & Preventionhave coordinated a program called "Business Responds toA.I.D.S." Its main initiative is to involve better educationby sensitizing executives, managers, and labor leaders. Ifthey draft new policies for their businesses, they will bestepping in the right direction (Collingwood 46). Smallindependent businesses can set their own policies but whatabout the large chain businesses? The commonly known department store "Macy's" came acrossan A.I.D.S. discrimination dispute. When Macy's haddiscovered that Mark Woodley, the usual Santa Claus, wasHIV-positive he was denied employment. They did however offerhim a job supervising the Santa Claus's, but he refused(Santa 22). Macy's tried to cover up by offering Mr. Woodleya job that did not involve the interaction of people. Thesituation was backed up by a protest march which resulted inchaos. One protestor John Winkleman states "A.I.D.S.discrimination violates the spirit of Christmas and we willnot tolerate it at all" (Santa 22). Some businesses do not want to deal with beingresponsible for someone who somewhere down the line mightbecome fatally ill. Insurance coverage is a main concern foremployees. The cost of treatment for A.I.D.S from the firstdiagnosis to death is an amount of $85,000 (Pogash 77). TheMedical staff of hospitals deal with HIV-positive patients ona daily basis. Nurses, unlike office employees orconstruction workers, perform invasive procedures on patientsproviding them with immediate care. This line of duty mayenforce stronger policies for their own legal protection(Kolasa 64). A survey was taken from Helen Lippman for RNmagazine. She reports "a caregiver's risk of infection aftera needlestick with contaminated blood, the CDC estimates isabout one in 200, and about one in 300 from percutaneousexposure" (30). Medical officials should be offered theseprotection plans, but should also become more sensitive tothe subject of discrimination. The City of Philadelphiafired emergency health physicians for refusing to give propertreatment to patients with A.I.D.S (Philadelphia 17). If youare put in a situation where you are working with someone whois infected or worrying of becoming infected yourself, youwould want to know what protection is offered after knowingthe rights of the caregiver (Kolasa 63).  A.I.D.S discrimination is no different than any otherform of prejudice. The only way it trails off the basic pathis that it can go either way. Whether you are a patient whois infected or a nurse who is infected. Whether you are anoffice employee or a client of an office employee. A.I.D.Sdoes not chose skin color, religion, or ethnic background.  It will get to anyone puts themselves at risk. If you add upall the hate and discomfort between people or groups ofpeople in our society who are prejudiced as it is, and addanother reason to take the hate to a higher level, theproblem will never be solved. Everyone must work togetherand become more educated about the way victims of thishourglass disease are treated. Black, White, Jewish, Asian,etc. Everyone has their opposing differences about oneanother, or how one race or belief is dominant over another. A.I.D.S is not prejudice. It has a hold on many groupsof these people. Health policies are offered for theprotection of the sick, but no policy will protect them fromthe emotional abuse. This is why we shouldn't turn our backson these people who are less fortunate. It's not going toget better. We must educate ourselves to not be soclose-minded, and start to get ahead of the game. Despiteall the irreconcilable differences between different types ofpeople who are infected ,they have one threatening thing incommon.....they are all dying. Educate not to discriminate. Are you so certain you will never be infected? --------------------- ---- WORKSCITED "A.I.D.S Protesters-as-Santa's at Macy's." New York Times -----30 Nov. 1991, sec. 1: 22. Annas, George. "Detention of HIV Positive Haitians at -----Guantanamo." The New England Journal of Medicine 329 (1993): 589-592.Collingwood, Harris. "A.I.D.S and Business: A Plan for Action." Business Week 14 Dec. 1992: 46.  Karr, Albert. "Employer A.I.D.S Policies begin to Proliferate The Wall Street Journal 15 Dec. 1992: A1. Kolasa, Eileen Urban. "HIV vs. a nurses right to work." RN January 1993: 63-68. Lewy, Robert. "HIV Infection and Job Performance." U.S.A  Today August 1992: 28-29. Lippman, Helen. "HIV and Professional Ethics: Nurses Speak Out." RN June 1992: 28-32. Peltz, James. "2 United Pilots File 1st A.I.D.S-Related Suit Against an Airline." Los Angeles Times 12 April. 1995: -----D1. "Philadelphia Resolves A.I.D.S. Bias Complaint." New York     Times 22 Mar. 1994, sec. A: 17 Pogash, Carol. "Risky Business (Coping with A.I.D.S. in the  -----workplace.)" Working Woman October 1992: 74-79. f:\12000 essays\health & humanities (196)\Aids Is There a Prevention Are There Cures .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AIDS:Is There a Cure? Are There Preventions? What is AIDS? How do you cure it? Find out by reading this report on cures and preventions for the AIDS virus. In this report some of the topics covered will be a small report on AIDS, preventions, and possible cures. This report was written to prove if there is a cure for the AIDS virus, and if there are any ways to prevent contracting AIDS. I mean who does AIDS think it is just killing people? AIDS is a virus that kills your immune system. The letters in AIDS stand for Acquired, Immune, Deficiency, Syndrome. (Madaras,185-6) There are four ways the AIDS virus can be spread. The first is by having sexual intercourse with someone infected with the virus. AIDS is transmitted this way by way of the semen. This is also the way most people get AIDS. (Madaras,187) The second most common way people get AIDS is by dirty intravenous needles. It is transmitted by the blood or other body fluids on the needle, and when someone else then uses the same needle, they have a high risk of catching the virus. The third most common way AIDS is spread is by blood transfusions. This is done almost the same way as by IV needle but it is always by the blood.(Madaras,187) The most rare way the AIDS virus is spread is by a mother passing it to fetus inside her.(Madaras,188) AIDS is a very rapidly-spreading disease although it is only spread four ways. Ten years ago only two cases of AIDS were known. Nine years ago only seven cases were known. In 1983 over 3,000 cases were recorded, and by 1989, there were more than 100,000 cases. (Samuel,26) Many people think you can get AIDS by what scientists call "casual contact." Casual contact is by such means as swimming pools, kissing, toilet seats, etc. "...it's important to remember that the AIDS virus doesn't live in the air or on things we touch, the way cold or flu viruses do. (Madaras,186) There have been no cases recorded where the infection was caused by casual contact. The part of your body that the AIDS virus kills is your immune system as mentioned before, but what it really kills is your white blood cells. White blood cells usually attack a virus when it enters the body. "It is a relatively new disease. The first cases in this country were discovered in 1981." (Madaras,185-6) Still, in all this time, scientists have not figured out a cure or vaccine for the virus because they do not even know how the AIDS virus cripples your white blood cells. A common symptom AIDS patients get is developing rare types of skin cancer. (Aids:Everything you should know,movie,AIMS,1989) Really AIDS doesn't kill you--other germs or viruses do because when they enter the body there is no immune system to protect your body so they can live freely. (Samuel,27) There is no 100% sure way to prevent AIDS, and there is always a possibility that you may contract the AIDS virus. (Aids:Everything you should know,movie,AIMS,1989) The only true 100% sure prevention from getting AIDS is called abstinence which means not having sex. (Madaras,166) The other way to protect yourself from AIDS when you have sex is by using condoms. Although condoms are not a 100% sure way to protect yourself from AIDS, it's still better than doing nothing. (Madaras,166) A condom is a thin piece of rubber that fits over the erect penis that traps the semen at the end. (Madaras,166) "Clearly it would be helpful and self protective if a person who has a high risk sexual life-style could at least modify it to make it less risky." (Nourse,128) The only really sure way to protect yourself from getting AIDS by needles is not to use them, but if you do, there are ways to prevent contracting AIDS. The first is not to use needles that someone else has used before you. Today doctors use different needles for each patient. (Madaras,187) The hardest way to prevent getting AIDS is when you are going to have a blood transfusion. A blood transfusion is when you're going to have surgery and you need somebody's blood to replace the blood that you lost during the operation. One way to protect yourself from AIDS when you're going to have a blood transfusion is by checking out the person that donated the blood and to see if he/she has contracted AIDS or has AIDS symptoms. The other way is to try to donate your own blood ahead of time. As I said before, since 1985 all blood must be scanned for the AIDS virus before it is used. (Aids:Everything you should know,movie, AIMS,1989) Many scientists today dedicate their whole lives to finding cures for some kind of disease and many of them are trying to find a cure for AIDS. Such drugs as AZT, DDL and Pyridinone have been used in attempting to retard the development of the AIDS symptoms. (Cowley,51) Although none of the above drugs actually cure AIDS, they do slow it down. In Michigan, a hospital has combined all three of the drugs in a test tube and the mixture killed the virus. They did this because the virus mutates so fast that one drug alone will not do it, but if you send AIDS three drugs, it can't fight them all at one time so it dies. (Cowley,51) These are all chemical cures but other scientists are also working on genetic cures. Wong Follie has dedicated almost her whole life to finding a cure for AIDS and other diseases. One of the possible cures she is working on works by making a semi-copy of the AIDS virus. The part that actually kills your immune system has been crippled. When the drone enters the body the immune systems fights it. So basically what it is doing is teaching the immune system how to kill the real AIDS virus when it comes. This has not actually been tested because of the time it takes to make the drone. So basically, in this report, you have found out that AIDS is a killer and that anyone is vulnerable to the disease. There is no 100% percent sure way to prevent the AIDS virus, so you better be very careful what you do. And finally, you learned that there is no 100% test-proven cure, so once you get it you're stuck with it forever. f:\12000 essays\health & humanities (196)\Aids US Made .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AIDS: US Made? In an article in the Summer-Autumn 1990 issue of "Top Secret", Prof. J. Segal and Dr. L. Segal illustrate their theory that AIDS is a man-made disease, originating at Pentagon bacteriological warfare labs at Fort Detrick, Maryland. "Top Secret" is the international edition of the German magazine Geheim and is a sister publication to the American Covert Action Information Bulletin (CAIB). Top Secret carries the Naming Names column, which CAIB is prevented from doing by the American government, and which names CIA agents in different locations in the world. The article, named "AIDS: US-Made Monster," is lengthy and has a lot of professional jargon. "The fatal weakening of the immune system which has given AIDS its name (Acquired Immune-Deficiency Syndrome)," write the Segals, "has been traced back to a destruction or a functional failure of the T4-lymphocytes, also called 'helper cells`, which play a regulatory role in the production of antibodies in the immune system." In the course of the illness, the number of functional T4-cells is reduced to such an extent that new anti-bodies cannot be produced and the defenseless patient remains exposed to a range of infections that under other circumstances would have been harmless. Most AIDS patients die from opportunistic infections rather than from the AIDS virus itself. The initial infection is characterized by diarrhea, erysipelas and intermittent fever. An apparent recovery follows after 2-3 weeks, and in many cases the patient remains without symptoms and functions normally for years. After several years, the pre-AIDS stage, known as ARC (Aids- Related Complex) sets in. This stage includes disorders in the digestive tract, kidneys and lungs. In most cases it develops into full-blown AIDS in about a year, at which point opportunistic illnesses occur. Disorders in various organ systems also occur, the most severe in the brain, the symptoms of which range from motor disorders to severe dementia and death. The Segals note that despite the fact that AIDS is transmitted only through sexual intercourse, blood transfusions and non- sterile hypodermic needles, the infection has spread dramatically. During the first few years after its discovery, the number of AIDS patients doubled every six months, and is still doubling every 12 months now though numerous measures have been taken against it. Based on these figures, it is estimated that in the US, which had 900,000 cases of AIDS in 1991, over 2,000,000 people will be afflicted with the virus by the year 2,000. It is also estimated that the number of people infected is at least ten times the number of those suffering from an acute case of AIDS. Even when a vaccination becomes available, it will not help those already infected. These and the following figures have been reached by several different sources, such as the US Surgeon General and the Chief of the medical services of the US Army. "AIDS does not merely bring certain dangers with it; it is clearly a programmed catastrophe for the human race, whose magnitude is comparable only with that of a nuclear war", say the Segals. They later explain what they mean by "programmed," showing that the virus was produced by humans, namely Dr. Robert Gallo of the Bethesda Cancer Research Center in Maryland. The first KNOWN cases of AIDS occurred in New York in 1979. The first DESCRIBED cases were in California in 1979. The virus was isolated in Paris in May 1983, taken from a French homosexual who had returned home ill from a trip to the East Coast of the US. One year later, Robert Gallo and his co-workers at the Bethesda Cancer Research Center published their discovery of the same virus, which is cytotoxic. (poisonous to cells) The Segals discuss the findings of Gonda et al, who compared the HIV, visna and other closely-related viruses and found that the visna virus is the most similar to HIV. The two were, in fact, 60% identical in 1986. According to findings of the Hahn group, the mutation rate of the HIV virus was about a million times higher than that of similar viruses, and that on the average a 10% alteration took place every two years. That would mean that in 1984, the difference between HIV and visna would have been only 30%, in 1982- 20%, 10% in 1980 and zero in 1978. "This means," say the Segals, "that at this time visna viruses changed into HIV, receiving at the same time the ability to become parasites in human T4-cells and the high genetic instability that is not known in other retroviruses. This is also consistent with the fact that the first cases of AIDS appeared about one year later, in the spring of 1979. In his comparison of the genomes of visna and HIV," add the Segals, "Coffin hit upon a remarkable feature. The envelope area of the HIV genome, which encodes the envelope proteins which help the virus to attach itself to the host cell, is about 300 nucleotides longer than the same area in visna." This behavior suggests that an additional piece has been inserted into the genomes of the visna virus, a piece that alters the envelope proteins and enables them to bind themselves to the T4-receptors, a piece which does not match the rest of the system biochemically. The above mentioned work by Gonda et al shows that the HIV virus has a section of about 300 nucleotides, which does not exist in the visna virus. That length corresponds with what Coffin described. That section is particularly unstable, which indicates that it is an alien object. The addition of HTLV-1 to visna made the HIV virus. In addition, the high mutation rate of the HIV genome has been explained by another scientific team, Chandra et al, by the fact that it is "a combination of two genome parts which are alien to each other by artificial means rather than by a natural process of evolution, because this process would have immediately eliminated, through natural selection, systems that are so replete with disorders." "These are the facts of the case," say the Segals. "HIV is essentially a visna virus which carries an additional protein monomer of HTLV-1....For this reason we can come to only one conclusion: that this gene combination arose by artificial means, through gene manipulation." "The construction of a recombinant virus by means of gene manipulation is extraordinarily expensive, and it requires a large number of highly qualified personnel, complicated equipment and expensive high security laboratories. Moreover, the product would have no commercial value. Who, then," ask the Segals, "would have provided the resources for a type of research that was aimed solely at the production of a new disease that would be deadly to human beings?" The English sociologist Allistair Hay, published a document whose authenticity has been confirmed by the US Congress, showing that a representative of the Pentagon requested in 1969 additional funding for biological warfare research. The intention was to create, within the next ten years, a new virus that would not be susceptible to the immune system, so that the afflicted patient would not be able to develop any defense against it. Ten years later, in the spring of 1979, the first cases of AIDS appeared in New York. In the fall of 1977, a P4 (highest security category of laboratory, in which human pathogens are genetically manipulated) laboratory was officially opened in building 550 of Fort Detrick, MD, the Pentagon's main biological warfare research center. "In an article in 'Der Spiegel`, Prof. Mollings point out that this type of gene manipulation was still extremely difficult in 1977. One would have had to have a genius as great as Robert Gallo for this purpose," note the Segals. In a supposed compliance with the international accord banning the research, production and storage of biological weapons, part of Fort Detrick was "demilitarized" and the virus section renamed the "Frederick Cancer Research Facility". It was put under the direction of the Cancer Research Institute in neighboring Bethesda, whose director was no other than Robert Gallo. This happened in 1975, the year Gallo discovered HTLV. Explaining how the virus escaped, the Segals note that in the US, biological agents are traditionally tested on prisoners who are incarcerated for long periods, and who are promised freedom if they survive the test. However, the initial HIV infection symptoms are mild and followed by a seemingly healthy patient. "Those who conducted the research must have concluded that the new virus was...not so virulent that it could be considered for military use, and the test patients, who had seemingly recovered, were given their freedom. Most of the patients were professional criminals and considering New York City's proximity to the prison many freed patients moved there. The patients were exclusively men, many of them having a history of homosexuality and drug abuse, as is often the case in American prisons. It is understandable why AIDS broke out precisely in 1979, precisely among men and among drug users, and precisely in New York City," assert the Segals. They go on to explain that whereas in cases of infection by means of sexual contact, incubation periods are two years or more, while in cases of massive infection via blood transfusions, as must have been the case with prisoners, incubation periods are shorter than a year. "Thus, if the new virus was ready at the beginning of 1978 and if the experiments began without too much delay, then the first cases of full-blown AIDS in 1979 were exactly the result that could have been expected." f:\12000 essays\health & humanities (196)\AIDS.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AIDS (acquired immunodeficiency syndrome) is a disease caused by a virus- HIV (human immunodiciency virus). The first cases in this country came to light in the early eighties. Although the origins of AIDS remains uncertain it is thought to have emerged decades ago in sub-Saharan Africa. There is a closely related virus (simian immunodeficiency virus, or SIV) that is found among monkeys in that particular area which AIDS is thought to have evolved from (Combating AIDS 353). When the virus first emerged in the United States it was localized to the male homosexual and IV drug user communities. This localization very quickly disappeared . AIDS is becoming a global epidemic. No country is safe from it. There has been AIDS cases reported around the world, in such places as the Caribbean, Southeast Asia, Southeast Mediterranean , and Oceania. This helps to show that AIDS knows no geographical boundries (Folks). This disease has been likened to the Black Plaque that decimated Europe during the middle ages. By April 1984, scientists had identified the virus responsible for AIDS and by March 1995 developed a blood test for it (Combating AIDS 355). This quick progress in the battle even lead Heckler, the secretary of health and human services, to say that a cure was just a few years away. Today, no cure is available and no sure treatment for AIDS symptoms is at hand. People are still contracting and dying from AIDS at an alarming rate. AIDS is a fatal disease that does not kill the patient. Its principle source of infection is the HIV virus which is a retrovirus. This means that the protein coat contains RNA instead of DNA and when the virus injects its genetic material into the host cell, it must first cause the cell to transcribe, using a unique enzyme called reverse transcriptase, it into complementary- DNA (c-DNA) before replication can occur. The virus is spherical in shape and is made of two parts: an envelop and core. The envelop is similar to a typical cell membrane (bilipid layer) imbedded with three proteins. The core section is bullet-shaped surrounded by a protein. Inside is the genetic material, RNA, covered by another protein (Combating AIDS 354). The HIV virus attacks the human helper T-cell or CD4-lymphocyte (part of the human immune defense system). This cell normally attacks and destroys foreign proteins and viruses. The normal CD4 T-lymphocyte is impervious to the HIV virus but if this cell produces a CD4 receptor molecule the HIV virus then has an entry into the cell. It attaches to the CD4 receptors on the cell surface. A portion of the virus then penetrates the cell membrane, fuses with it and then the HIV virus injects its core into the cell. Proteins in the core cause the receptor cell to manufacture the viral c-DNA. This c-DNA then becomes a part of the cells genetic material. When this happens what is known as a provirus is formed. This provirus can remain unexpressed for years which is why a lot of HIV positive people do not show AIDS symptoms for years. When some activator stimulates the provirus, then viral RNA and the HIV proteins are synthesized and new HIV viruses are produced (Nowak 964). When activated, the virus causes a suppression of the immune system so that one or more "opportunistic" diseases can gain a foothold. It is one of these diseases which eventually kills the patient. An "opportunistic " disease is one which a normal person's immune system can successfully defend against. When something occurs that damages the immune system, then these diseases abound (Folks). One of the symptoms of full blown AIDS is dementia. This was thought to be caused by encephalitis (inflammation of the brain). New evidence suggests that the AIDS virus itself destroys neurons in the brain even though it does not infect them. In laboratory findings the level of neurons in the brains of dead AIDS patients was forty percent less than in non AIDS brains. The brains of dead AIDS patients showed signs of HIV but the majority did not show signs of encephalitis. It is proposed that the protein coat on HIV may interfere with VIP (a brain protein) which some neurons need in order to send signals (Walker 311). There are many areas of research in determining what causes the activation of HIV. New evidence supports the theory that there is a cofactor involved with the accelerated onset of AIDS. This cofactor is thought to be a mycoplasma-a primitive bacteria. The effect seems to be indirect. The mycoplasma seems to stimulate the cell to produce substances called cytokine. Certain cytokines are immune system simulators that are known to activate HIV. To test the theory, scientist conducted an experiment in which human CD4 lymphocytes were infected with a mycoplasma, or HIV alone began dying off but eventually recovered. The cells with both died off but did not recover. This seems to indicate that something about the mycoplasma infection promotes the growth of HIV (Ezzell 133). Another suspected cofactor is Herpesvirus-6. This is a virus that is normally carried by most people. It infects CD4 cells and causes them to produce the CD4 receptor molecule. The CD4 cell, normally a killer cell is itself destroyed by the herpesvirus-6. In those cells not destroyed, the herpesvirus-6 may actually work in tandem with the HIV virus to destroy the normally viral resistant CD4 cells (Fackelmann / Herpesvirus 215). Another theory, the autoimmune theory, is proposed by Gene Shearer of the National Institute of Allergy and Infectious Diseases states that the HIV virus tricks the immune system into attacking itself. In an experiment, mouse lymphocytes were inoculated into another strain of mice inducing an antibody response against HIV but also possibly against the infected lymphocyte itself. This response was similar to the graft vs. host response that causes many grafts to be rejected unless the immune system is suppressed by drugs. Two other scientists, Kion and Hoffman, of the University of British Columbia in Vancouver, say that the HIV infection produces two effects, one against the helper cells (CD4) and another one against the suppresser cells ( a set of immune system cells that stabilize the helper cells) (Combating AIDS 368). There is a lot of controversy in the theories surrounding the processes governing the development of AIDS after a person is infected. There is a long and highly variable incubation period with roughly fifty percent of male homosexuals developing the disease within ten years after infection ( Folks). One phase of research has been devoted to the body's natural immune system. In a research project, seven young homosexual men were identified with early stag HIV. This is normally very hard to do because most people do not get tested until they start showing signs of the virus or other opportunistic illnesses and by that time the virus has multiplied many times making testing of the early stages impossible. The blood studies showed that in the first stages of the disease, there is an enormous burst of HIV growth in the body (numbers that are comparable to those patients with full blown, severe, AIDS). The tests taken over the next days revealed a significant drop in the levels of the virus population and a substantial rise in the antibody population. At full scale antibody production, little or no HIV virus was detected. The bodies immune system had successfully shutdown production of the HIV virus. These researchers are now concentrating on trying to figure out why the bodies immune system does not continuously defend against the invading HIV virus (Gorman 62). The standard test for the HIV virus involves taking a blood sample from the suspected individual and testing it for HIV antibodies. The body almost always develops antibodies to viruses. It usually takes a few weeks to a few months for the HIV antibodies to develop after infection with the HIV virus and sometimes longer. Some reports show that it can sometimes take years for the antibodies to show up. Once a patient tests positive for the HIV virus, further tests are done. One of the newest blood tests scans for an obscure adrenal hormone that seems to forecast full blown AIDS. DHEA (dehydroepiandrosterone-a steriod) is thought to help protect against heart disease, cancer, and viral infections among other things. There seems to be between low levels of DHEA and the onset of full blown AIDS. There is also some evidence that shows DHEA inhibits HIV replication thus, helps shield against HIV progression. As a result a drug firm is beginning to manufacture a synthetic form of DHEA to tests its help against AIDS (Fackelmann / Mysterious 277). There are several ways that doctors are treating the symptoms of AIDS. As the opportunistic diseases occur, there are treated symptomatically (ex. pneumonia is treated with antibiotics). In general most patients are treated with AZT, a drug that though it many side effects it is thought to be effective in slowing down the progress of the HIV virus. There is a new drug, ddI (dideoxgenosine), available to those patients who can not tolerate AZT or for whom it is no longer effective. DdI may also useful in combination with AZT. The cost for ddI is about twenty percent less than that of AZT. AZT is also used in combination with other drugs (Combating AIDS 348). Another drug that is still in the experimental stage is Phosphorodithioate DNA. This structure is being hailed as a potential drug in that it is hoped to interfere with the transcribing of the viral RNA into c-DNA which is crucial for the replication of the HIV virus. Cell culture studies of the drug have showed no toxicity at 10uM concentrations but this drug is only in the laboratory state (Cowley 70). Another avenue of protection against HIV infection is with finding a vaccine that will protect against HIV invasion. In 1990, a new HIV vaccine was tested on individuals rated low risk for HIV infection. They were given a vaccine made using a synthetic protein that mimics the protein found in the HIV virus protein coat. The trial was a partial disappointment. The vaccine was proven safe but seemingly none effective. It was not only none effective but it in six recipients it caused a phenomenon that stimulates an increases in the infectious rate of viruses. Some recipients did develop antibodies to the protein but most of these antibodies weakened after a year. The results were inconclusive as to whether or not the antibodies would protect against the HIV virus (Weiss 38). Another researcher, Jonas Salk, is in the process of testing an AIDS vaccine based on a deactivated HIV virus stripped of its protein coat (Science and Society 34). Although there is a lot of ongoing research into cures for AIDS and prevention of AIDS, t f:\12000 essays\health & humanities (196)\Alcohol y Drogas.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Cuando se habla de drogas, a nivel internacional, se piensa en la heroína, la morfina o la cocaína, que se han convertiodo en problemas cada vez más graves, con sus actividades delictuales, conocidas "narcotráfico". Las formas más peligrosas de conseumo son por inyección intravenosa, que crea una rápida dependencia física y siquíca, es decir, toda la vida del adicto dependera de la ingestión de nuevas dosis. En el plano nacional, la droga más divulgada, especialmente entre la juventud, ha sido la marihuana, consumida como el cigarrillo. A ella se agregó luego la inhalación de vapores de algunos pegamentos, como el neopren. Ultimamente se han comprobado otras formas, con la apariencia de cierta legalidad, mediante el consumo de fármacos, como anfetaminas y muchos remedios adquiridos sin la receta médica correspondiente. Suele argumentarse en "defensa" de algunas de estas drogas, que son menos peligrosas y dañinas que otras. Sin embargo, esto es una trivialidad, pues el daño común de las drogas es la adicción. De modo que mucho antes de llegar a las graves consecuencias para su salud física, el niño, el adolescente, jóven o adulto, hombre o mujer, habra causado a su vida daños irreparables, como la perdida de la vergüenza, de la estima y la autoestima, todo lo que podrá hacer en su camino para conseguir la droga, incluso el robo, sin contar los múltiples riesgos de accidentes fatales. Tipos de Drogas Cánnabis Género de plantas herbáceas pertenecientes a la familia cannabáceas. Tiene hojas compuestas y flores verdes. Destaca la especie Cannabis sativa o cáñamo. De la planta femenina del Cannabis indica se extraen la marihuana y el hachís Estupefacientes Los estupefacientes se clasifican en opiáceos, como la heroína, morfina, codeína y metadona; barbitúricos, como el valium y otros sedantes; estimulantes, como la cocaína y anfetaminas; derivados del cannabis, como el hachís, grifa, marihuana; y alucinógenos, como el LSD, mescalina, peyote, etc. Pueden ser naturales o producidos en laboratorio y en la mayoría de los casos crean adicción o hábito, por lo que su comercio está limitado o prohibido. Esto ha provocado la aparición de un mercado negro de proporciones internacionales, estrechamente relacionado con el mundo del delito. Cocaína Alcaloide extraído de las hojas de la coca, que a veces se utiliza como anestésico local. Aspirada en forma de polvo o inyectada, se convierte en una droga, que actúa sobre el sistema nervioso central y provoca euforia; su uso continuado puede dar lugar a graves trastornos psíquicos y físicos. Se obtiene en grandes plantaciones de América del Sur (Bolivia y Colombia, principalmente) y su creciente consumo en los países desarrollados ha generado una amplia red de tráfico ilegal, conocida como narcotráfico Crack Tipo de droga compuesta principalmente por cocaína. LSD (siglas de LySergic acid Diethylamide) Dietilamida del ácido lisérgico. Es una droga de efectos alucinógenos que se sintetiza a partir de los alcaloides del cornezuelo del centeno. Su comercialización y consumo están penados por las leyes. Peyote Planta de la familia cactáceas, especie Echinocactus Williamsii. Es un cactus que mide entre 15 y 20 cm de altura, tiene forma cilíndrica, flores rosas y carece de espinas. Contiene numerosos alcaloides y su extracto se utiliza como droga alucinógena. Crece en Texas y México. Mescalina Alcaloide que se obtiene del peyote, planta de América del Norte; tiene un alto poder alucinógeno y fue usado por los indios de México en prácticas ceremoniales religiosas. Heroína Alcaloide derivado de la morfina*, en forma de polvo blanco de sabor amargo. Es un poderoso sedante que se utiliza como estupefaciente*. Produce importantes daños al organismo, agravados por su alto grado de adicción. Su fabricación, comercialización y consumo están penados por las leyes, lo que no impide su tráfico en el mercado negro. Morfina C17H19O3N. Alcaloide del opio. Fue aislado en 1806 por Sertürner. Es un potente narcótico que actúa sobre el sistema nervioso central y es utilizado en medicina como analgésico. Su consumo incontrolado produce adicción y graves trastornos fisiológicos y psíquicos. Opio Sustancia que se obtiene secando el jugo de las cabezas de la planta llamada adormidera verde (Papaver somniferus). El opio se refina y de él se extraen alcaloides narcóticos como la morfina, heroína y codeína, cuyo consumo puede crear hábito, por lo que deben utilizarse con precaución y sólo para usos médicos. Metadona Producto farmacéutico de efectos semejantes a los de la morfina y la heroína, que se utiliza para desintoxicar a los drogadictos; su uso produce dependencia Alcaloide Sustancia nitrogenada orgánica, de carácter débilmente básico, que se encuentra en algunas plantas y constituye el excitante de ciertos productos, como la cafeína en el café y la nicotina en el tabaco. Los alcaloides suelen ser venenosos y muchos tienen aplicaciones médicas, como la quinina, la morfina, la codeína, etc Analgésico Medicamento o fármaco capaz de aliviar o suprimir el dolor, disminuyendo la capacidad de reacción de los centros cerebrales correspondientes. Son muy usados los preparados con ácido acetilsalicílico, como la aspirina. Los derivados del opio (morfina, heroína) son más potentes, pero crean hábito y se reservan para circunstancias especiales. Hachís Sustancia extraída de cierta variedad del cáñamo indio, que se usa como droga Cafeína Sustancia estimulante del sistema nervioso central y del corazón, contenida en bebidas como el té, café, cacao, cola, etc. Es un alcaloide y su abuso produce arritmia cardiaca, dolor de cabeza e insomnio. TABAQUISMO Hasta hace pocos años, fumar era considerado un hábito considerado poco menos que distinguido. Sin embargo, estudios científicos comprobaron que el tabaco, ademas de producir una adicción, como cualquier otra droga, aumentaba sus peligros en compañia de otros ingredientes usados en la fabricación del cigarrillo, como el alquitrán. Está comprobado que el tabaco afecta el aparato respiratorio, provocando enfermedades como faringitis, laringitis, bronquitis crónica y enfisema. Ataca al sistema cardiovascular, provocando arteriosclerosis e infarto al miocardio. Afecta además el aparato digestivo y el sistema nervioso. Y es indudablemente, la causa de un alto porcentaje de cáncer al pulmón. Nicotina C10H14N2. Alcaloide presente en las hojas del tabaco. Es un líquido aceitoso, tóxico, de olor fuerte y sabor picante que excita el sistema nervioso. Se utiliza como aditivo en varios productos letales, como los insecticidas, y también en medicina y como curtiente El humo del tabaco contiene nicotina y alquitranes que afectan al aparato respiratorio, pudiendo producir bronquitis crónica y asma, al aparato nervioso y al aparato digestivo, con riesgo de ocasionar gastritis y duodenitis. El tabaco es también cancerígeno y favorece el infarto de miocardio. ALCOHOLISMO La OMS define al alcoholico como un bebedor "que presenta una interferencia con su salud mental o corporal, sus relaciones interpersonales y su correcto funcionamiento social y económico". Por lo tanto necesita tratamiento. Se ha investigado que en Chile un 13% de la población mayor de 15 años es bebedor excesivo, es decir, que consume más de un litro de vino al día o su equivalente entre otros licores, y otro 13% es alcoholico, o sea, que presenta dependencia física del alcohol, no puede dejar de beber. Se ha comprobado también un alto grado de consumo de bebidas alcoholicas en niños y adolescentes. EL alcohol produce daños físicos, disminución de la actividad muscular y de la actividad neuromuscular, causante de múltiples accidentes. Afecta al estómago, provocando gastritis crónica, o en casos más graves, cirrosis hepática, con daños irreparables para el hígado. Ataca las células nerviosas, causando delirios, périda de la memoria, alucinaciones, etc. f:\12000 essays\health & humanities (196)\Alcoholism 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Alcohol is the most used and abused drug in the world, for this reason there is no wonder why we have alcohol problems. The most common problem is alcoholism. Alcoholism is a chronic usually progressive disease that includes both a psychological and a physical addiction to alcohol. Alcoholics know what will happen to them when they drink but they are so addicted they can't stop drinking. Alcohol becomes the most important part of the person's life. It totally consumes them, all their thoughts and actions have to do are somehow associated with alcohol. Alcoholism like other illnesses will become worse without treatment and remain life-threatening as long as it is left untreated. The psychological dependence an alcoholic has is when they think alcohol is necessary and life will not be good without it. The physical dependence an alcoholic has is when their body becomes so used to the drug that it now needs alcohol to function without pain. Alcoholism is not a disease experienced only by adults. Alcoholism, like any illness, can strike at any age. Ten percent of the adult drinkers in the U.S are considered alcoholics or at least experience drinking problems to some degree. Surveys have shown that more than one out of three Americans have a personal friend or relative who has had a drinking problem for ten years or longer. Almost two out of three Americans report that they know someone who drinks too much. It is estimated that there are 18 million alcoholic or problem drinkers in the U.S. For every alcoholic there are at least four other people who are affected by the alcoholic. This means that in the U.S. there are at least seventy-two million other people dealing with the disease somehow. Many people believe that alcoholics are people that are the skid row winos and bums. This is a common misconception, actually ninety-four percent of alcoholics live at home, while only six percent are the skid row type. Ninety percent of all alcoholics are employed, and many work for years before their alcoholism becomes so bad that they cannot perform their job. Federal officials estimate that the abuse of alcohol costs the economy well over one-hundred billion dollars every year. Alcohol does this by making people be less productive at work, taking more sick days, sustaining on the job injuries, collecting more workmen's compensation, and increasing health insurance premiums. Physical Effects Prolonged alcohol use like that of an alcoholic can lead to permanent damage of your body. The liver is the organ of the body most vulnerable to damage by alcohol because the liver is where the alcohol is broken down. The liver may become worn out from the daily task of removing alcohol from the blood, this may cause the liver to be unable to perform as well in removing other harmful substances. One of the most dangerous diseases of the liver caused by long-term alcohol use is cirrhosis of the liver. Cirrhosis causes the liver to become inflamed and scarred, which eventually kills the liver and the person. Over fourteen thousand deaths a year from cirrhosis are directly related to alcohol. Alcohol causes an increase in blood pressure, this makes the heart pump harder to move blood around the body. Alcohol can cause an increase in heart rate while at the same time reducing the ability of the heart muscle to pump, it can also cause abnormal heart rhythms. Long-term and heavy use of alcohol can cause a condition of the heart called alcoholic cardiomyopathy, this impairs the heart muscles ability to contract and eventually fail. Alcohol's action on the brain is what causes people to feel intoxicated. A sudden intake of large amounts of alcohol may result in death, this is because nerve impulses to the brain are dangerously blocked. There are over two hundred deaths a year from this kind of accidental alcohol poisoning. Alcohol also has an increasing effect on our brain chemistry this is what causes are change behavior. This can make people do things that they would not do when they are sober, this a is common sign of an alcoholic. Test have shown that long-term drinking like that of an alcoholic can lead to a measurable loss of thinking ability. Over time heavy drinking can also cause permanent damage to the central nervous system. Research has shown that there seems to be an association between alcohol and cancer, with heavy drinkers having the highest risk. Drinkers seem to get cancer more frequently than non-drinkers. Scientists believe that alcohol weakens body tissue and makes them more susceptible to cancer causing substances. Alcohol is considered a factor in over seven thousand cases of cancer a year. Alcohol hurts heavy drinkers health in general, consuming large amounts of alcohol over a long period of time harms their bodies and shortens their life. On average, heavy drinkers are taking twelve to fifteen years off their lives. How People Become Alcoholics It is believed that there are many different ways a person can become a alcoholic. Alcohol alone does not cause alcoholism, if it did everyone who drank would be any alcoholic. There are a number of factors that lead to alcoholism. The way most scientists think you become an alcoholic is through genetics. Because of genetics people tend to inherit an inability to handle alcohol, just like other people inherit other diseases from their parents. This is the reason that alcoholism seems to run in families from generation to generation. This is why some people become alcoholics from the first time they drink, because of the genetics they become hooked from the start. Experiments testing the genetic factor have been conducted by taking children of alcoholics at birth and placing them in non-alcoholic families, despite having no exposure to the alcoholic parents the children had a four times higher risk of becoming an alcoholic than children of non-alcoholic parents. Another reason people become alcoholics is the environment they grow up in. If children are exposed to drinking as a activity in which drinkers are careful and moderate they are more likely to become a responsible drinker. If the children grow up seeing heavy alcohol use and abuse they are more likely to use alcohol in that way. Also, if the children are exposed to large amounts of peer pressure from the kids around them they are more likely to drink. Alcoholism is also a disease that can be acquired over a long period of time. Alcoholics may start out as social drinkers who are able to control their drinking, but they may lose this control and be carried into the alcoholic class. Some people may drink daily just out of habit on a controlled level. But they may become careless about their habits and the step across the line to alcohol dependence is a short one. Once they are dependent on the alcohol they will build a tolerance to it, this will cause them to drink more and more to get the same effects. Drinking more only makes their dependence worse and eventually they will develop into a full blow alcoholic. Women Alcoholics Alcoholism is a disease people see as mostly a male problem. But this is incorrect, as many as half of the nation's alcoholics are women. The reason it seems there are not as many female alcoholics is that female alcoholics are usually closet drinkers. You rarely see a woman alcoholic publicly show alcoholic behavior, while with men it is very common. It is easier for a woman alcoholic to damage her body than it is for a man. The physical damage is worse than men's because women wait longer to seek help because society places a greater stigma on o woman who drinks to much. Women's livers don't process alcohol as well as men's. This makes women alcoholics susceptible to developing cirrhosis and other liver problems with lower levels of alcohol in their bodies and after shorter periods of drinking. Large amounts of alcohol in women may interfere with fertility by upsetting the hormones in their body and it can increase the chance of a miscarriage. Women alcoholics who become pregnant can cause great damage to their babies, this damage is called fetal alcohol syndrome, fetal alcohol syndrome can cause physical deformities and mental retardation. Women alcoholics also have a higher rate of relapse than males. Violence and Alcoholism Being an alcoholic probably means you will be under the influence of alcohol quite a bit, which increases your chances of doing something stupid or illegal more than the regular person. Alcohol causes a change in brain chemistry which results in changed behavior such as increased aggression and reduced fear which may lead us to take needless risks. Alcohol can cause people to be rude, verbally abusive, and physically threatening. These factors almost always lead to trouble, such as fights with family , friends, or even complete strangers. Some people use alcohol to express hostile feelings that the wouldn't express when sober. Alcohol is a major factor in the committing crimes. Two out of three murders, one out of three rapes, and two out of five results are connected to the use of alcohol. This comes of no surprise to me because it is almost everyday you here of someone committing a crime while under the influence. Traffic deaths caused by alcohol are very common in the U.S. This shows that alcohol not only hurts the people drinking but also innocent people. One out of two traffic deaths are caused by alcohol and nearly twenty-five thousand Americans die each year as a result of the eight hundred thousand car accidents caused by alcohol. Alcoholics are seven times more likely to be involved in fatal accidents than non-alcoholics. Alcohol is also related to three out of five cases of child abuse, up to one out of two incidents of domestic violence, one out of three suicides, and up to seven out of ten deaths by drowning. What I'm trying to point out here is that when people use alcohol, especially frequently and heavily like alcoholics do, they are just setting themselves up to get hurt or hurt someone else. Getting Help Early identification and treatment of alcoholism is the best way to prevent alcohol from ruining your life. The first and most important thing an alcoholic can do is admit that they have a problem. It is unlikely that the alcoholic will be the first to admit it, usually they will deny they have a problem, first they will deny their problem to others and then to themselves. But once the alcoholic admits they have a problem, they are on the road to victory. After they admit they have a problem they have to decide for themselves that they want to stop drinking for good. Another very crutial part of recovery is recognizing alcoholism itself as the problem needing attention, rather than saying it is just secondary to another underlying problem. There are many places an alcoholic can get help from like: family, friends, health-care workers, Alcoholics Anonymous, and alcoholism counselors. They can provide the moral support the alcoholic needs to get well. Alcoholics may need to check into a detox center if really bad, because the withdrawals can be very painful and could possibly cause death. Withdrawal reactions can include any or all of these: high fever, loss of appetite, nausea, uncontrollable shaking, hallucinations, and possible coma or death. Alcoholism is a disease that cannot be totally cured but people can recover and return to a normal way of life. Recovering depends on total abstinence from alcohol. Recovering alcohol's can never touch alcohol again because their addiction is too strong. Alcoholism is a very serious disease that affects a large number of people. I think if we educate children at an early age to use alcohol in moderation and within a reasonable limit we would have less cases of alcoholism. We also now have the ability, through technology, to detect which people will most likely develop into alcoholics. I think with this information we should get these people help right away, the sooner the better. There is still hope for today's and tomorrow's alcoholics because they are able to recover from alcoholism. It will only get easier to recover from it if more people get involved in the fight against alcoholism. Bibliography Microsoft Encarta Encyclopedia Alcoholism Internet Webpage Alcohol and Health Notes Magazine Today's Health Magazine Alcoholism by Chris Varley Problem Drinking - What's The Problem? * How Alcohol Affects Your Body * Alcohol At Work * Living With An Alcoholic Parent * How To Asses Your Drinking * * References marked by stars are Life Skills Education Pamphlets f:\12000 essays\health & humanities (196)\Alcoholism.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Alcoholism Alcoholism refers the drinking of alcohol to such a degree that major aspects of one's life are seriously and repeatedly interfered with. These aspects include work, school, family relationships, personal safety and health. Alcoholism is considered a disease. It has known physical, psychological and social symptoms. An alcoholic continues to drink even despite the destructive consequences. Alcoholism is serious and progressive. It can be fatal if not treated. Alcoholism is a very complex disorder. An alcoholic who stops drinking for a while is considered recovering, not cured. A person does not have to drink every day in order to be considered an alcoholic. Likewise, someone who drinks frequently or gets drunk every once and a while is not necessarily and alcoholic. It is possible to abuse alcohol for a short period of time without developing alcoholism. For example, some people may drink abusively during a personal crisis and then resume normal drinking. College students tend to drink more heavily than other age groups. It is often difficult to distinguish such heavy and abusive drinking from the early stages of alcoholism. How well the person can tolerate giving up alcohol for an extended time and the effects of drinking on the family, friends, work, and health, may indicate the extent of the alcohol problem. More than ten million Americans are estimated to be alcoholic. Alcoholism is found in all ages, cultures and economic groups. It is estimated that 75 percent of alcoholics are male and 25 percent are female. Alcoholism is a worldwide problem, but is most widespread in France, Ireland, Poland, Scandinavia, Russia and the United States. Some common symptoms of alcoholism in the early stages are constant drinking for relief of personal problems, an increase in one's tolerance for alcohol, memory lapses or blackouts while drinking, and an urgent craving for alcohol. In the middle and late phases, dependence on alcohol causes tremors and agitation only relievable by alcohol. Most likely, a combination of biological, psychological, and cultural factors contribute to the development of alcoholism in any individual. Alcoholism often seems to run in families. Although there is no conclusive indication of the alcoholic family member is associated, studies show that 50 to 80 percent of all alcoholics have had a close alcoholic relative. Some researchers believe that one inherits an addiction for alcohol. Studies on animals and twins seem to support this theory. One study suggests that a susceptibility to alcoholism may be linked to a gene on chromosome eleven. Alcoholism may also be related to emotional problems. For example, alcoholism is sometimes associated with a family history of maniac-depression. Some alcoholics have used alcohol medicate a depressive disorder. Alcoholics commonly drown their depressed or anxious feelings with alcohol. Some may drink to reduce inhibitions or negative feelings. Many alcoholics share experiences of loneliness, frustration, or anxiety but there is no single personality type that will become an alcoholic. Alcoholism is a complex disorder for which a combination of treatments may be necessary for recovery. If the alcoholic is in the acute phase of alcoholism and is suffering from complications such as delirium tremens or serious health problems, hospitalization may be necessary. Because alcoholism is a chronic condition however, hospitalization is only the first step toward recovery. Many alcoholics go through several hospital stays of detoxification, before committing themselves to a program for recovery. A comprehensive treatment plan can include various facilities. Facilities are available in most cities. No one can make an alcoholic commit himself to recovery. Some therapists suggest, however, that family members may influence the alcoholics by not supporting drinking activities, by seeking therapy for themselves, and not joining the alcoholic's denial of the problem. The involvement of family members can aid the progress of recovery. I feel that alcoholism is a major problem. It can cause the break up of families and marriages. It is important that if someone knows someone that is an alcoholic, they should try to get that person help. Alcoholism is very dangerous if not treated. f:\12000 essays\health & humanities (196)\Alexander the Great.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Alexander III According to Plutarch, Alexander was born on the sixth of Hecatombaeon (July) in the year 356 B.C. He was the son of Philip, king of Macedon,and Olympias. Supposedly on the day he was born the temple of Artemis burnt down, signifying his future glory. Not much is known of the youth of Alexander. It is known that he was taught by Aristotle and had a love of the Greek epic poems. One famous story from his youth is told in Plutarch's life of Alexander. Philonius the Thessalian brought the horse Bucephalus to Philip offering to sell him for thirteen talents. Philip and his attendants brought the horse to a field to try him. When they got there none of Philip's attendants could even mount him. They were leading the horse away when young Alexander asked for a chance to ride him. A wager was made that if Alexander could not ride the horse he would pay the price for the horse. After the wager was made Alexander took the horse and pointed him in the direction of the sun. He had noticed that the horse was afraid of his own shadow. He then mounted the horse and began to ride, to the amazement of all who watched. When he got off the horse Philip kissed his son. Plutarch also tells of Alexander entertaining Persian ambassadors while his father was not present. When Alexander was 16 Philip left him in charge of Macedon when Philip went to fight the Byzantines. When Alexander was 20 his father was murdered at the theatre. Some say that Alexander had a part in the plot to assasinate his father but almost all agree that his mother Olympias was a key figure in the death of Philip. Whatever the case may be Alexander took the throne in 336 B.C. Alexander is known for his conquest into Persia. When there, he performed hellenization. Hellenization is the attempt to become "Greek." Alexander helped this process along in the lands that he conquered. Another of the things that Alexander did was he set up cities where ever he went. Garrisons were left in these cities. These colonists would become the ruling class. They would then impose laws or rules to promote hellenization. Also in these cities gymnasiums were set up. Gymnasiums were the center of most Greek cities. What better way to make Persian cities similar to Greek cities than by setting up institutions such as these. Another deliberate way that Alexander tried to hellenize had to do with setting up a school. Alexander recruited 30,000 Persian boys to enroll in this school to learn Greek and Greek ways of life. I think the most effective way that Alexander hellenized had to due with his army. First he let Persians into his army. These new members of his army would have to learn how to speak Greek to understand orders. The Persians would also pick up Greek customs from being in the camps with Alexander's army. Secondly, Alexander encourages his soldiers to marry Persian women. Alexander himself had Persian wives. There was even a mass marriage in Susa, where Alexander married 80 of his top officials to Persian women. Why would a Persian want to become Greek? Well, there are six main reasons. It would help to know what's going on. To achieve unity. If you wanted to join army, it would be necessary. You would need it for trade. Necessary to abide by the Greek laws. Maybe they weren't nationalistic at all,and had no problems with changing. Although Alexander tried to Hellenize Persia what actually happened was a Persianization of Alexander. Alexander began to take on Persian ways. He may have been doing this for political reasons. Maybe he hoped that the Persians would respond better to a Persian king than a Greek one. One of the things that Alexander things was take the title of "Great King" and all the things that go along with it. Alexander wanted to be worshipped as a God and even claimed to be descended from divinity. He wanted everybody to engage in proskynesis, that is the act of bowing before the king. The Persians were more than happy to do this but it caused problems between Alexander and the Macedonians in his court. That is another thing that Alexander did. He established a Royal Court, which included both Persians and Macedonians. Alexander also started to dress like a Persian. He wore silk and long pants. He also took on multiple wives. Alexander became more Persian than the Persians became Greek. This Persianization may be the cause of his death. The Macedonians might have gotten a little upset at this and bumped him off. After the attempted mutinies, Alexander and his troop began the long journey back. One thing that doesn't make sense is why Alexander would travel through Gedrosia instead of staying with his ships and sailing the Persian Gulf. Gedrosia is a desert region. Why walk you're army through the desert? Some say it was to imitate ancient heroes who had been said to have made the journey. One thing that occurred on the journey through the desert was what I consider to be the greatest party ever, due to its originality. Alexander's army had just filled up on rations upon entering Gedrosia. When he refreshed his army he continued the march, feasting all the way for seven days. He and his most intimate friends banqueted and revelled night and day upon a platform erected on a lofty, conspicuous scaffold, which was slowly drwan by eight horses. This was followed by a great many chariots, some covered with purple canopies, and some with green boughs, which were continually supplied afresh, and in them the rest of his commanders drinking. There was no target or spear in sight. Instead the soldiers handled nothing but goblets of wine, drinking to each other's health. All places resounded with music of pipes and flutes, with harping and singing. Don't forget the women dancing in the rites of Bacchus(naked). This rolling party lasted until they reached the royal palace of Gedrosia. There the party didn't stop, but lasted for several more days. Aexander the Great also had a party in Ecbatana. Alexander was in Ecbatana twice. The first time was in pursuit of Darius after the battle at Gaugamela. While there he captured all the gold that was there. There he stayed until marching east, leaving Parmenion there as a garrison. The second time in Ecbatana is the one that is more important to me. In the autumn of 324, Alexander went to Ecbatana for the sole purpose of a three month drinking binge. Plutarch tells us this story. When he came to Ecbatana in Media, and had despatched his most urgent affairs, he began to divert himself again with spectacles and public entertainments, to carry on which he had a supply of 3000 actors and artists, newly arrived out of Greece. Alexander's plan of three months of pleasure was quickly interrupted. Alexander's closest companion and suspected lover, Hephaestion fell sick of a fever. Being a young man and a soldier he had to continue to party and drink heavily. While his doctor, Glaucus was at the theatre, Hephaestion ate a fowl for dinner, and drank a large draught of wine. He quickly fell ill and shortly thereafter, died. Alexander was so completely upset that he ordered the tails and manes of all the horses be cut to show respect. He then crucified the doctor, Glaucus. Alexander III had another party in Susa. Susa was the adminsrative capital of the Persian empire. Alexander first went to Susa shortly after the Battle of Gaugamela. There he took control of the money, totalling 50,000 talents($60 million) as well as the rest of the royal property. Alexander was again in Susa in 324 B.C. There he performed a mass marriage. Between eighty and a hundred Macedonian officials took one Persian women each, including Hephaestion and Ptolemy. Alexander himself took two new brides. The wedding was done in traditional Persian style. The bridegroom would sit down in chairs, after a toss the brides came in, took them by the hand, and kissed them. Every guest that sat down for the banquet(roughly 30,000) had a gold cup before them. The celebration went on for no less than 5 days. There was also a big parade in the park. f:\12000 essays\health & humanities (196)\Alzheimers Disease 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Alzheimer's Disease by: Michael Sang Alzheimer's Disease Introduction to Alzheimer's Alzheimer's disease is a progressive degenerative disease of the brain. It is first described by the German neuropathologist Alois Alzheimer (1864-1915) in 1905. This disease worsens with advancing age, although there is no evidence that it is cause by the aging process. The average life expectancy of a person with the disease is between five and ten years, but some patients today can live up to 15 years due to improvements in care and medical treatments. The cause of Alzheimer's has not been discovered yet and it cannot be possible to confirm a person has Alzheimer's until their autopsy following death. How does Alzheimer's develop What causes Alzheimer's? Well no one know exactly the development of this debilitating disease. But recent advances has produced several clues as to how it is born. Initially when we study the brain of a Alzheimer's victim, we focus on two specific areas. One is the cortex of the frontal and cerebral lobes1. The second is the hippocampus (meaning seahorses in Greek which it resembles2) which is located below the cerebral cortex and responsible for short-term memory. If we study samples of these two section, we would find three irregularities which are not found in normal brain matter. These three are called neurofibrillary tangles, neuritic plagues and granulovacuolar degeneration3. A nerve cell has numerous axons and dendrites coming out of it. A neurofibrillary tangle is when the neuron changes. A number of dendrites are missing and the nucleus is filled with protein filaments resembling steel wool4. Although all elderly people has a few of these helix shaped bundles in their brain for they are normal indicators of aging, Alzheimer's patients has more than usual. Their presence usually in the frontal and temporal lobes is a indication of AD. Senile neuritic plagues are small round objects. They are masses of amyloid protein material composed of residue left over from healthy nerve endings that were broken off and decayed. Their presence near the cell further indicates something gone wrong. Neuritic plaques is the best evidence for diagnostics to make the determination of AD. A third sign of neuron deterioration is granulovacuolar degeneration. This is when fluid-filled vacuoles are seen crowding inside the nerve cell, specifically in the triangular shaped cells of the hippocampus. This condition can only be observed in carefully sliced, stain and analyzed brain tissue. The cell having lost all it's dendrites and nucleus soon disintegrates entirely, vanishing into the body's waste disposal system. With the depletion of enough nerve material the brain actually shrinks, sometimes by as much as ten percent5. The more cells the AD sufferer loses, the more mental functions he loses. Soon the person will have limited motor skills. People who were once witty and quick on their feet were reduced to the mental status of small children. Diagnosis of Alzheimer's How would you now if a person you knew has Alzheimer's? There are certain telltale signs that point to it. There was one patient6 that was convinced she was suffering from AD. As proof of her condition, she bought the a meeting several recent newspaper clippings, which she began to quote from memory. Obviously this person did not have the disease, she wouldn't have memorized complex and lengthy information. But forgetting on a regular basis doesn't indicate Alzheimer's either. Stages of AD In the initial stage, there is no clear evidence of memory trouble and deterioration in brain functions. The individual performs well on exams that test mental abilities (psychometric tests7) similar to those given to measure IQ. In the second stage, the patient shows very mild memory problems with difficulty in remembering names of friends. The changes at this point is still very small. Occasionally, the patient might make a surprising statement such as inquiring about the health of a friend who everyone knows, died years ago. Only extensive psychometric testing can determine if the person's mental ability changed. A close family member like a husband or wife might suspect something is wrong. By the third stage, there is definite evidence of memory loss, which might interfere with job performance, The person might have difficulty competing a job that use to be routine. The person may avoid social situations because he or she realizes there's a problem In stage four there is clinical evidence of memory impairment when the mental status is tested by doctors. The disease has now become obvious to the family. A sign of this stage is when the patient keeps asking the same question which has already been answered, this make daily companionship difficult because his friends and family are frustrated. By stage 5, the patient show problems with both recent and past memories, they even forget events that are important like Christmas, birthdays, friendships and interests. Judgment is failing, the individual is no longer able to select clothes for a particular weather of season and cannot match items by color. Eventually, the victim of AD may leave the water running, the stove on, or the front door open. At this point wandering becomes a major problem. In stage six, understanding of languages diminishes and simple commands aren't understood. Victims may go back to their first language if they have one. Eventually languages disappear entirely. In stage seven or the terminal stage, the victim becomes bedridden and totally dependent for all functions. He cannot speak coherently and can't eat unassisted. Death usually occurs at this stage form aspiration pneumonia8, pneumonia caused by breathing in food or other objects because the victim doesn't remember how to swallow food safely, or from urinary infections. Recent Research on Alzheimer's Some progress has been made in understanding the nature of the Alzheimer's disease. Scientists has recently found medicine that can slow down the progress of AD. The average survival period from the time of diagnosis to death in 1985 is 10 years. Today the rate has increase a third to 15 years9. A recent media release stated the discovery of a mutant gene called "triplet repeat" disease genes10. These genes produce proteins that may block from properly functioning key enzymes that are important to the production of energy in the brain. This gene was found in several diseases like AD, Huntingtons, and Haw River Syndrome as well as three other rare neurological disorders. Another press release from the Alzheimer's Association is one concerning the new study of an important advance toward early detection of AD11. "Through investigations such as these, in addition to those involving apolipoprotien E (APOE), positron emission tomography (PET), and other approaches, we will improve our ability for accurate detection of individual at risks for the disease"12 said Zaven Khachaturian Ph.D., director of the Alzheimer's Association's Ronald and Nancy Reagan Research Institute. Among the drugs being tested to treat AD are -Cholinergic agents: choline, lecithin, and the agonist (RS 86, arecholine, and bethanechol) -Peptides: vasopressin, ACTH 4-10, naloxone -Nootropic agents: pramiracetem, CI 911, Praxilene, Oxiratem -other general drugs: chelating agents, Nimodipine, Vinpocetine13 most of these are still in experimental stages. Some has proved to work slightly but is generally unsafe, others has tested safe but not beneficial, but none has been both. People who offer "cures" to Alzheimer's are either frauds or ignorant14. When people realizes that AD is a serious disease, perhaps as much as HIV, then maybe they will pay attention. The reason why there hasn't been a cure is because scientists tries to attract grants by working on a problem that people think is serious and controversial. If there was as much attention that was paid to AIDS as there was in AD, then maybe there will be an answer. f:\12000 essays\health & humanities (196)\Alzheimers Disease.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Alzheimers Disease What is Alzheimers Disease? The most common form of dementing illness, Alzheimers Disease (AD) is a progressive, degenerative disease that attacks the brain, causing impaired memory, thinking and behavior. The person with AD may experience confusion, personality and behavior changes, impaired judgment, and difficulty finding words, finishing thoughts or following directions. It eventually leaves its victims incapable of caring for themselves. What happens to the brain in Alzheimers Disease? In AD The nerve cells in the part of the brain that controls memory, thinking, are damaged, interrupting the passage of messages between cells. The cells develop distinctive changes that are called neuritic plaques (clusters of degenerating nerve cell ends) and neurofibrillary tangles (masses of twisted filaments which accumulate in previously health nerve cells). The cortex (thinking center) of the brain shrinks (atrophies), The spaces in the center of the brain become enlarged, also reducing surface area in the brain. What are the symptoms of Alzheimers Disease? Alzheimers Disease is a dementing illness which leads to loss of intellectual capacity. Symptoms usually occur in older adults (although people in their 40s and 5Os may also be affected) and include loss of language skills such as trouble finding words, problems with abstract thinking, poor or decreased judgment, disorientation in place and time, changes in mood or behavior and changes in personality. The overall result is a noticeable decline in personal activities or work performance. Who is affected by Alzheimers Disease? Alzheimers Disease knows no social or economic boundaries and affects men and women almost equally. The disease strikes older persons more frequently, affecting approximately 10% of Americans over age 65 and 47% of those over age 85. Is Alzheimers Disease hereditary? There is a slightly increased risk that children, brothers, and sisters of patients with Alzheimers Disease will get it, but most cases are the only ones in a family. Some patients who develop the disease in middle age (called early onset) have a "familial" type more than one case in the family. It is important to note that AD can only be definitively diagnosed after death through autopsy of brain tissue. Thirty percent of autopsies turn up a different diagnosis. Families are encouraged to ask for an autopsy as a contribution to learning more about the genetics of AD. Are there treatments available for Alzheimers Disease? Presently, there is no definite cure or treatment for Alzheimers Disease. Unfortunately, there are many unscrupulous individuals who market so-called "cures." These treatments are often expensive and they dont cure AD. However, since senility is such a scary problem and because families are desperate to find help for loved ones, these bogus treatments continue to sell. Most of them have no scientific proof of effectiveness. What is the scope of Alzheimers Disease? Alzheimers afflicts approximately 4 million Americans and its estimated that one in three of us will face this disease in an older relative. More than 100,000 die annually, making Alzheimers Disease the fourth leading cause of death among adults. Half of all current nursing home patients are affected, making AD a costly public health and long term care problem. An estimated $80 billion is spent annually on the care of AD, including costs diagnosis, treatment, nursing home care, at-home care and lost wages. Alzheimers also affects the patients caregivers, who become the second victims. Persons with AD often require 24-hour care and supervision, most of which is provided in the home by family and friends. In addition to the tremendous stress of providing care, families also bear most of the financial burdens of the disease as well. f:\12000 essays\health & humanities (196)\Alzheimer's Disease.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ALZHEIMER'S DISEASE We are currently living in the age of technology. Our advancements in the past few decades overshadow everything learned in the last 2000 years. With the elimination of many diseases through effective cures and treatments, Canadians can expect to live a much longer life then that of their grandparents. In 1900 about 4% of the Canadian population was over the age of 65. In 1989 that figure tripled to 12% and the government expects that figure to rise to 23% by the year 2030 (Medical,1991,p.13). This increase has brought with it a large increase in diseases associated with old age. Alzheimer's dementia (AD) is one of the most common and feared diseases afflicting the elderly community. AD, once thought to be a natural part of aging, is a severely debilitating form of mental dementia. Although some other types of dementia are curable or effectively treatable, there is currently no cure for the Alzheimer variety. A general overview of Alzheimer's disease including the clinical description, diagnosis, and progression of symptoms, helps one to further understand the treatment and care of patients, the scope of the problem, and current research. The clinical definition of dementia is "a deterioration in intellectual performance that involves, but is not limited to, a loss in at least 2 of the following areas: language, judgement, memory, visual or depth perception, or judgement interfering with daily activities" (Institute,1996, p.4). The initial cause of AD symptoms is a result of the progressive deterioration of brain cells (neurons) in the cerebral cortex of the brain. This area of the brain, which is the largest and uppermost portion, controls all our thought processes, movement, speech, and senses. This deterioration initially starts in the area of the cortex that is associated with memory and then progresses into other areas of the cortex, then into other areas of the brain that control bodily function. The death of these cells causes an interruption of the electrochemical signals between neurons that are a key to cognitive as well as bodily functioning. Currently AD can only be confirmed at autopsy. After death the examined brain of an Alzheimer victim shows two distinct characteristics. The first is the presence of neuritic plaques in the cerebral cortex and other areas of the brain including cerebral blood vessels. These plaques consist of groups of neurons surrounded by deposits of beta-amyloid protein. The presence of these plaques is also common to other types of dementia. The second characteristic, neurofibliary tangles, is what separates AD from all other forms of dementia. Neurofibliary tangles take place within the disconnected brain cells themselves. When examined under a microscope diseased cells appear to contain spaghetti-like tangles of normally straight nerve fibers. The presence of these tangles was first discovered in 1906 by the German neurologist Alois Alzheimer, hence the name Alzheimer's disease. Although the characteristics listed above are crucial to the diagnosis of AD upon death, the clinical diagnosis involves a different process. The diagnosis of AD is only made after all other illnesses, which may have the same symptoms, are ruled out. The initial symptoms of AD are typical of other treatable diseases therefore doctors are hesitant to give the diagnosis of Alzheimer's in order to save the patient from the worsening of a treatable disease through a misdiagnosis. Some of the initial symptoms include an increased memory loss, changes in mood, personality, and behavior, symptoms that are common of depression, prescription drug conflict, brain tumors, syphilis, alcoholism, other types of dementia, and many other conditions. The onset of these symptoms usually brings the patient to his family doctor. The general practitioner runs a typical battery of urinalysis and blood tests that he sends off to the lab. If the tests come back negative, and no other cause of the symptoms is established, the patient is then refereed to a specialist. The specialist, usually a psychiatrist, will then continue to rule out other possible illnesses through testing. If the next battery of tests also comes back negative then the specialist will call on a neurologist to run a series of neurological examinations including a PET and CAT scan to rule out the possibility of brain tumors. A spinal tap is also performed to determine the possibility of other types of dementias. The patient will also undergo a complete psychiatric evaluation. If the patient meets the preliminary criteria for AD an examination of the patients medical history is also necessary to check for possible genetic predispositions to the disease. The psychiatric team finally meets with the neurological team to discuss their findings. If every other possible disease is ruled out, and the results of the psychiatric evaluation are typical to that of a person with AD, the diagnosis of Alzheimer's disease is given. The initial symptoms of AD are usually brushed off as a natural part of aging. The myth that a person's memory worsens over time is just that - a myth (Myers,1996, p.100-101). AD's victims are mostly over the age of 65 and many delay treatment by attributing their problems to age. A victim might forget a well known phone number or miss an important appointment. These symptoms eventually escalate to the total disintegration of personality and all patients end up in total nursing care. In descending order, the patient goes from (1) decreased ability to handle a complex job to (2) decreased ability to handle such complex activities of daily life as (3) managing finances, (4) complex meal preparation and (5) complex marketing skills.Next comes (6) loss of ability to pick out clothing properly, (7) or to put on clothing properly, followed by (8) loss of ability to handle the mechanics of bathing properly. Then (9) progressive difficulties with continence and (10) toileting occur, followed by (11) very limited speech ability and (12) inability to speak more than a single word. Next comes (13) loss of ambulatory capability. Last to go are such basic functions as (14) sit up, (15) smile and (16) hold up one's head (Brassard,1993,p.10). The average time from diagnosis to inevitable death is 8 years. The family of the victim is usually able to care for the victim for an average period of about 4 years (Alzheimer's, 1996,p.44).During the progression of the disease between 10% and 15% of patients hallucinate and suffer delusions, 10% will become violent and 10% suffer from seizures (Alzheimer's,1996,p.46). Once a person is diagnosed as having AD, an assessment is made of the disease's stage of progression and of the strengths and weaknesses of the victim and the victim's family. There are different types of assessments available to evaluate the level of dysfunction of the patient. Based on one of these assessments a care plan is put together by a team consisting of a family member, a paid or unpaid care provider, and the victim's physician. Throughout the progression of the disease, and depending on the needs of the patient, a wide range of expensive medication, such as psychoactive drugs to lift depression and sedatives to control violence, may be required. Unfortunately, although a wide range of treatments have been tested, most prove to be ineffective. At the beginning of the disease the family is able to look after the patient without much effort. Frequently families will hire a care giver in order to alleviate some of the work. Simple changes in the home can make life much easier for the sufferer, help them keep their self esteem, and prolong their stay at home. Examples of low-cost modifications to the environment include reducing the noise levels in the home (telephones, radios, voices, etc.); avoiding vividly patterned rugs and drapes; placing locks up high or down low on doors leading outside (AD sufferers are known to wander off); clearing floors of clutter; reducing the contents of closets in order to simplify choices (Alzheimer,1992, p.17). These costs are paid for by the victim's family. Many of these, and other more expensive modifications are introduced in long-term care settings. They help in maintaining the safety and security of the victim as well as reducing their confusion. The patient's and the family's condition should be assessed every six months (Alzheimer,1992, p.21). In response to constantly changing needs, the aspects of care must be constantly modified. Other issues that usually arise during the care of the patient are assessment of the competence of the victim, power of attorney, and response to and prevention of abuse (Aronson,1988, p.124). Eventually the victim's condition deteriorates to the point where home care is no longer possible and they must be moved to a long-term care facility. In Canada care, support and information for victims and their families comes from the health care system and the Alzheimer's Society of Canada. The care giver must obtain information and education about the disease in order to effectively care for the victim. During the course of the disease victims might wander, hallucinate, become suspicious. This behavior can place a large strain on the care giver as well as causing depression and deterioration of their own health (Aronson,1988, p.132). An AD support group is crucial to alleviating some of the stress on the care giver. Through a support group the care giver is given the emotional and practical help needed to accomplish the large task of looking after the victim for as long as possible. Currently there are 300,000 persons in Canada with AD. This figure is more than that of Parkinson's disease, cancer and multiple sclerosis combined. With continuous growth in the percentage of Canadians over the age of 65, this figure could hit 700,000 by the year 2020 (Carlton,1996,p.17). These large and increasing figures translate into a large burden on the health care system. Even when using the most conservative estimates of the average number of years spent in an institution and the number of afflicted Canadians, the costs to health care are immense. At $33,000 (1989) per patient per year in an institution and with an average stay of three years until death, the cost of AD will amount to $3 billion over the next three years; and if the entry into the disease state remains constant, it will cost the Canadian taxpayer [an added] $1 billion per year thereafter.(Brassard,1993,p.11) There have been many studies that conclude that the number of incidences of AD is on the rise. A very high incidence was reported in a U.S. survey conducted in East Boston by the Harvard Medical school. It showed the incidence of AD to be 3% for people between the ages of 65-74, 18.7% for those between 75-84, and 47.2% for those over 84 (Evans,1989,p.4). AD is a democratic disease. It affects persons of both sexes and all races and ethnic backgrounds. The major risk factors for AD are age and heredity. Persons with a high incidence of AD in their family history are most succeptable. A specific subtype of AD exists that is solely connected to heredity. This subtype is known as Familial Alzheimer's disease (FAD). FAD is also known as Early Onset Alzheimer's disease, named so because its symptoms start to develop much earlier than in the regular sporadic type. Only 5%-10% of all cases are of this type. FAD is suspected when AD can be traced over several generations and there is a history of, among previously affected family members, a similar age of onset and duration of the disease ( usually 4 years ) . Approximately 50% of the children of an affected parent go on to develop the disease (Pollen,1993,p.89). Much research has been conducted in an attempt to locate the gene that is responsible for FAD. Currently, researchers have isolated genes 1, 14, and 21 (Alzheimer's,1996,p.36), however, the evidence still remains inconclusive (Statement,1996, p.2). There is also a possibility that a specific genetic mutation merely puts a person at risk to the disease and AD is triggered by an external force e.g. a head injury.(Statement,1996,p.4). Finding the specific location of the gene will pave the way for a diagnostic or even predictive test for FAD. Similar genetic tests already exist for cystic fibrosis and muscular dystrophy. Locating the AD gene will also allow scientists to study why the particular gene is not functioning properly and may give clues to treatment and cure. The long term goal of this research is the same as that of any other genetic research and that is gene therapy - which is the possibility that science could one day alter our genetic make-up. The other much more common type of AD is Sporadic Alzheimer's Disease (SAD). This includes all other types of the disease which are not linked to heredity. Genetic research is also playing a major role in the progress towards a diagnostic or predictive test for SAD. Recently, a gene involved in the transport of cholesterol has been identified to be associated with AD. Apolipoprotein E is located on chromosome 19 and seems to contribute to the succeptability of a persons to AD (Statement,1996,p.6). The gene exists in three different forms or alleles (Apo E 2,3,4) and each person has a combination of two of the three. Thus an individual can have any one of the following combinations: Apo E 2/2, 3/3, 4/4, 2/3/, 3/4 or 2/4. Researchers have found a relationship between the number of copies of the 4 allele and the person's probability of developing the disease. Source: Institute for Brain Aging FIGURE 1 illustrates an analysis of the proportion of individuals remaining normal at increasing ages for two, one, or zero copies of Apo E 4...For example a 75 year old individual with the Apo E 4 genotype has approximately a 20% chance of remaining normal; Apo E 3/4 or 2/4, 40%; 2/2, 3/3 or 2/3, a 75% chance. For many years, scientists believed that aluminum was at the root of AD. High levels of aluminum were detected in the areas surrounding the beta-amyloid plaques associated with neural atrophy (Pollen,1990,p.77). Recently, however, this theory has been abandoned. Scientists concluded that the build-up of aluminum was a direct result of the wrongful use of a particular test agent employed in the studies (Brown,1992, p.6). Some of the current pursuits of research are in the areas of viral infection, malfunction of the immune system, and chemical imbalances. One of the hardest theories to disprove is that AD is the result of a slow acting virus present at birth (Carlton,1996,p.13). Others believe that AD is an immune system disorder. Support for this theory comes from the presence of beta-amyloid plaques identical to those found in AD brains in the post mortem examinations of immuno-deficiency disease victims (Alzheimer's,1996,p.22). The detection of lower neurotransmitter substances such as acetylcholine, serotonin, norepinephrine and somatostatin in AD sufferers forms the basis of another theory that says AD is brought on by a chemical imbalance in the brain. Treatment of patients with drugs that block the break down of neurotransmitter substances in the brain have been met with limited success (Brassard,1993,p.16). AD is an enormous social and economic problem. As the population ages, the number of victims will steadily increase, imposing a massive burden on the health care system. Until a cure and effective treatment are found AD will remain a terrible disease that slowly eats away at that which is the very essence of a person, their mind, leaving in its wake a mere empty shell of that person. It takes away from all of us the insightful wisdom of society's most prized possession - the elderly. References Alzheimer Society of Canada.(1992).Guidelines for Care.Toronto: Alzheimer Society of Canada. Alzheimer's Disease Education and Referal Centre.(1996).Internet.http:\\www.alzheimers. org/adear.drct.txt Aronson, Miriam.(1988).Understanding Alzheimer's disease.New York: Scribner's. Brassard, Daniel.(1993).Alzheimer's Disease.Ottawa: Library of Parliament, Science and Technology Division. Brown, Phyllida.(1992, November 7).Alzheimer's May Not be Linked to Aluminum.New Scientist Supplement,p.6. Carlton University Department of Health Sciences Freenet.(1996).Internet.http:\\www.nct.carlton ca/fp/social.services/alzheimer/disease.dir Evans, Denis, et al.(1989).Prevalence of Alzheimer's Disease in a Community Population of Older Persons.Journal of the American Medical Association,272(15),1152. Institute for Brain Aging.(1996).Internet.http:\\www.128.200.55.17/aboutad.html Medical Research Council of Canada.(1991).Presidents Report 1989-1990. Myers, David.(1996).Exploring Psychology.New York: Worth. Pollen, Daniel.(1990).Hannah's Heirs: The Quest For the Genetic Origins of Alzheimer's Disease.London:Oxford University Press. Statement on Use of Apolipoprotein E Testing for Alzheimer's Disease.(1996).American College of Medical Genetics/American Society of Human Genetics Working Group on ApoE and Alzheimer's Disease.Internet.http:\\www.faseb.org/genetics/asng/policy/pot f:\12000 essays\health & humanities (196)\Alzheimers.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Alzheimer's Disease Alzheimer's Disease is a progressive and irreversible brain disease that destroys mental and physical functioning in human beings, and invariably leads to death. It is the fourth leading cause of adult death in the United States. Alzheimer's creates emotional and financial catastrophe for many American families every year. Fortunately, a large amount of progress is being made to combat Alzheimer's disease every year. To fully be able to comprehend and combat Alzheimer's disease, one must know what it does to the brain, the part of the human body it most greatly affects. Many Alzheimer's disease sufferers had their brains examined. A large number of differences were present when comparing the normal brain to the Alzheimer's brain. There was a loss of nerve cells from the Cerebral Cortex in the Alzheimer's victim. Approximately ten percent of the neurons in this region were lost. But a ten percent loss is relatively minor, and cannot account for the severe impairment suffered by Alzheimer's victims. Neurofibrillary Tangles are also found in the brains of Alzheimer's victims. They are found within the cell bodies of nerve cells in the cerebral cortex, and take on the structure of a paired helix. Other diseases that have "paired helixes" include Parkinson's disease, Down's Syndrome, and Dementia Pugilistica. Scientists are not sure how the paired helixes are related in these very different diseases. Neuritic Plaques are patches of clumped material lying outside the bodies of nerve cells in the brain. They are mainly found in the cerebral cortex, but have also been seen in other areas of the brain. At the core of each of these plaques is a substance called amyloid, an abnormal protein not usually found in the brain. This amyloid core is surrounded by cast off fragments of dead or dying nerve cells. The cell fragments include dying mitochondria, presynaptic terminals, and paired helical filaments identical to those that are neurofibrillary tangles. Many neuropathologists think that these plaques are basically clusters of degenerating nerve cells. But they are still not sure of how and why these fragments clustered together. Congophilic Angiopathy is the technical name that neuropathologists have given to an abnormality found in the walls of blood vessels in the brains of victims of Alzheimer's disease. These abnormal patches are similar to the neuritic plaques that develop in Alzheimer's disease, in that amyloid has been found within the blood-vessel walls wherever the patches occur. Another name for these patches is cerebrovascular amyloid, meaning amyloid found in the blood vessels of the brains. Acetylcholine is a substance that carries signals from one nerve cell to another. It is known to be important to learning and memory. In the mid 1970s, scientists found that the brains of those afflicted with Alzheimer's disease contained sixty to ninety percent less of the enzyme choline acetyltransferase(CAT), which is responsible for producing acetylcholine, than did the brains of healthy persons. This was a great milestone, as it was the first functional change related to learning and memory, and not to different structures. Somatostatin is another means by which cells in the brain communicate with each other. The quantities of this chemical messenger, like those of CAT, are also greatly decreased in the cerebral cortex and the hippocampus of persons with Alzheimer's disease, almost to the same degree as CAT is lost. Although scientists have been able to identify many of these, and other changes, they are not yet sure as to how, or why they take place in Alzheimer's disease. One could say, that they have most of the pieces of the puzzle; all that is left to do is find the missing piece and decipher the meaning. If treatment is required for someone with Alzheimer's disease, then the Alzheimer's Disease and Related Disorders Association(ADRDA), a privately funded, national, non- profit organization dedicated to easing the burden of Alzheimer victims and their families and finding a cure can be contacted. There are more than one hundred and sixty chapters throughout the country, and over one thousand support groups that can be contacted for help. ADRDA fights Alzheimer's on five fronts 1- funding research 2- educating and thus increase public awareness 3- establishing chapters with support groups 4- encouraging federal and local legislation to help victims and their families 5- providing a service to help victims and their families find the proper care they need. ---------- Of all the scientists to emerge from the nineteenth and twentieth centuries there is one whose name is known by almost all living people. While most of these do not understand this man's work, everyone knows that its impact on the world of science is astonishing. Yes, many have heard of Albert Einstein's General Theory of relativity, but few know about the intriguing life that led this scientist to discover what some have called, "The greatest single achievement of human thought." Einstein was born in Ulm, Germany on March 14, 1874. Before his first birthday, his family had moved to Munich where young Albert's father, Hermann Einstein, and uncle set up a small electro-chemical business. He was fortunate to have an excellent family with which he held a strong relationship. Albert's mother, Pauline Einstein, had an intense passion for music and literature, and it was she that first introduced her son to the violin in which he found much joy and relaxation. Also, he was very close with his younger sister, Maja, and they could often be found in the lakes that were scattered about the countryside near Munich. As a child, Einstein's sense of curiosity had already begun to stir. A favorite toy of his was his father's compass, and he often marvelled at his uncle's explanations of algebra. Although young Albert was intrigued by certain mysteries of science, he was considered a slow learner. His failure to become fluent in German until the age of nine even led some teachers to believe he was disabled. Einstein's post-basic education began at the Luitpold Gymnasium when he was ten. It was here that he first encountered the German spirit through the school's strict disciplinary policy. His disapproval of this method of teaching led to his reputation as a rebel. It was probably these differences that caused Einstein to search for knowledge at home. He began not with science, but with religion. He avidly studied the Bible seeking truth, but this religious fervor soon died down when he discovered the intrigue of science and math. To him, these seemed much more realistic than ancient stories. With this new knowledge he disliked class even more, and was eventually expelled from Luitpold Gymnasium being considered a disruptive influence. Feeling that he could no longer deal with the German mentality, Einstein moved to Switzerland where he continued his education. At sixteen he attempted to enroll at the Federal Institute of Technology but failed the entrance exam. This forced him to study locally for one year until he finally passed the school's evaluation. The Institute allowed Einstein to meet many other students that shared his curiosity, and It was here that his studies turned mainly to Physics. He quickly learned that while physicists had generally agreed on major principals in the past, there were modern scientists who were attempting to disprove outdated theories. Since most of Einstein's teachers ignored these new ideas, he was again forced to explore on his own. In 1900 he graduated from the Institute and then achieved citizenship to Switzerland. Einstein became a clerk at the Swiss Patent Office in 1902. This job had little to do with physics, but he was able to satiate his curiosity by figuring out how new inventions worked. The most important part of Einstein's occupation was that it allowed him enough time to pursue his own line of research. As his ideas began to develop, he published them in specialist journals. Though he was still unknown to the scientific world, he began to attract a large circle of friends and admirers. A group of students that he tutored quickly transformed into a social club that shared a love of nature, music, and of course, science. In 1903 he married Mileva Meric, a mathematician friend. In 1905, Einstein published five separate papers in a journal, the Annals of Physics. The first was immediately acknowledged, and the University of Zurich awarded Einstein an additional degree. The other papers helped to develop modern physics and earned him the reputation of an artist. Many scientists have said that Einstein's work contained an imaginative spirit that was seen in most poetry. His work at this time dealt with molecules, and how their motion affected temperature, but he is most well known for his Special Theory of Relativity which tackled motion and the speed of light. Perhaps the most important part of his discoveries was the equation: E= mc2. After publishing these theories Einstein was promoted at his office. He remained at the Patents Office for another two years, but his name was becoming too big among the scientific community. In 1908, Einstein began teaching party time at the University of Berne, and the following year, at the age of thirty, he became employed full time by Zurich University. Einstein was now able to move to Prague with his wife and two sons, Hans Albert and Eduard. Finally, after being promoted to a professor, Einstein and his family were able to enjoy a good standard of living, but the job's main advantage was that it allowed Einstein to access an enormous library. It was here that he extended his theory and discussed it with the leading scientists of Europe. In 1912 he chose to accept a job placing him in high authority at the Federal Institute of Technology, where he had originally studied. It was not until 1914 that Einstein was tempted to return to Germany to become research director of the Kaiser Wilhelm Institute for Physics. World War I had a strong effect on Einstein. While the rest of Germany supported the army, he felt the war was unnecessary, and disgusting. The new weapons of war which attempted to mass slaughter people caused him to devote much of his life toward creating peace. Toward the end of the war Einstein joined a political party that worked to end the war, and return peace to Europe. In 1916 this party was outlawed by the government, and Einstein was seen as a traitor. In that same year, Einstein published his General Theory of relativity, This result of ten years work revolutionized physics. It basically stated that the universe had to be thought of as curved, and told how light was affected by this. The next year, Einstein published another paper that added that the universe had no boundary, but actually twisted back on its self. After the war, many aspects of Einstein's life changed. He divorced his wife, who had been living in Zurich with the children throughout the war, and married his cousin Elsa Lowenthal. This led to a renewed interest in his Jewish roots, and he became an active supporter of Zionism. Since anti-Semitism was growing in Germany, he quickly became the target of prejudice. There were many rumors about groups who were trying to kill Einstein, and he began to travel extensively. The biggest change, though, was in 1919 when scientist who studied an eclipse confirmed that his theories were correct. In 1921, he traveled through Britain and the United States raising funds for Zionism and lecturing about his theories. He also visited the battle sites of the war, and urged that Europe renew scientific and cultural links. He promoted non-patriotic, non-competitive education, believing that it would prevent war from happening in the future. He also believed that socialism would help the world achieve peace. Einstein received the Nobel Prize for Physics in 1922. He gave all the money to his ex-wife and children to help with their lives and education. After another lecture tour, he visited Palestine for the opening the Hebrew University in Jerusalem. He also talked about the possibilities that Palestine held for the Jewish people. Upon his return he began to enjoy a calmer life in which he returned to his original curiosity, religion. While Einstein was visiting America in 1933 the Nazi party came to power in Germany. Again he was subject to anti-Semitic attacks, but this time his house was broken into, and he was publicly considered an enemy of the nation. It was obvious that he could not return to Germany, and for the second time he renounced his German citizenship. During these early years in America he did some research at Princeton, but did not accomplish much of significance. In 1939 the second World War began to take form. There was heated argument during this time over whether the United States should explore the idea of an atomic bomb. Einstein wrote to President Roosevelt warning him of the disaster that could occur if the Nazi's developed it first. Einstein did not participate in the development of the bomb, but the idea did stem from his equation E=mc2. Just as he knew that the bomb was under development, he also knew when it was going to be used. Just before the bomb was dropped on Japan Einstein wrote a letter to the President begging him not to use this terrible weapon. The rest of Einstein's life was dedicated to promoting peace. After the war ended, he declared, "The war is won, but the peace is not." He wrote many articles and made many speeches calling for a world government. His fame, at this point, was legendary. People from all over would write to him for advice, and he would often answer them. He also continued his scientific research until the day he died. This was on April 18, 1955. There is no doubt that he was dissatisfied that he never was able to find the true meaning of existence that he strove for all his life. Bibliography Clark, Ronald W., Einstein - The Life and Times, New York: World Publishing, 1971. Dank, Milton, Albert Einstein, New York: An Impact Biography, 1920. Dukas, Helen and Banesh Hoffman, eds., Albert Einstein: The Human Side, Princeton: University Press, 1979. Einstein, Albert, Carl Seelig, ed., Ideas and Opinions, New York: Bonanza Books, 1954. "Einstein, Albert." Random House Encyclopedia, Random House Press, 1990 edition. Hunter, Nigel, Einstein, New York: Bookwright Press, 1987. Nourse, Dr. Alan E., Universe, Earth, and Atom: The Story of Physics, New York and Evanston: Harper & Row, Publishers, 1969. ---------- Bill of Rights How many rights do you have? You should check, because it might not be as many today as it was a few years ago, or even a few months ago. Some people I talk to are not concerned that police will execute a search warrant without knocking or that they set up roadblocks and stop and interrogate innocent citizens. They do not regard these as great infringements on their rights. But when you put current events together, there is information that may be surprising to people who have not yet been concerned: The amount of the Bill of Rights that is under attack is alarming. Let's take a look at the Bill of Rights and see which aspects are being pushed on or threatened. The point here is not the degree of each attack or its rightness or wrongness, but the sheer number of rights that are under attack. Amendment I Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. ESTABLISHING RELIGION: While campaigning for his first term, George Bush said "I don't know that atheists should be considered as citizens, nor should they be considered patriots." Bush has not retracted, commented on, or clarified this statement, in spite of requests to do so. According to Bush, this is one nation under God. And apparently if you are not within Bush's religious beliefs, you are not a citizen. Federal, state, and local governments also promote a particular religion (or, occasionally, religions) by spending public money on religious displays. FREE EXERCISE OF RELIGION: Robert Newmeyer and Glenn Braunstein were jailed in 1988 for refusing to stand in respect for a judge. Braunstein says the tradition of rising in court started decades ago when judges entered carrying Bibles. Since judges no longer carry Bibles, Braunstein says there is no reason to stand -- and his Bible tells him to honor no other God. For this religious practice, Newmeyer and Braunstein were jailed and are now suing. FREE SPEECH: We find that technology has given the government an excuse to interfere with free speech. Claiming that radio frequencies are a limited resource, the government tells broadcasters what to say (such as news and public and local service programming) and what not to say (obscenity, as defined by the Federal Communications Commission [FCC]). The FCC is investigating Boston PBS station WGBH-TV for broadcasting photographs from the Mapplethorpe exhibit. FREE SPEECH: There are also laws to limit political statements and contributions to political activities. In 1985, the Michigan Chamber of Commerce wanted to take out an advertisement supporting a candidate in the state house of representatives. But a 1976 Michigan law prohibits a corporation from using its general treasury funds to make independent expenditures in a political campaign. In March, the Supreme Court upheld that law. According to dissenting Justice Kennedy, it is now a felony in Michigan for the Sierra Club, the American Civil Liberties Union, or the Chamber of Commerce to advise the public how a candidate voted on issues of urgent concern to their members. FREE PRESS: As in speech, technology has provided another excuse for government intrusion in the press. If you distribute a magazine electronically and do not print copies, the government doesn't consider you a press and does not give you the same protections courts have extended to printed news. The equipment used to publish Phrack, a worldwide electronic magazine about phones and hacking, was confiscated after publishing a document copied from a Bell South computer entitled "A Bell South Standard Practice (BSP) 660-225-104SV Control Office Administration of Enhanced 911 Services for Special Services and Major Account Centers, March, 1988." All of the information in this document was publicly available from Bell South in other documents. The government has not alleged that the publisher of Phrack, Craig Neidorf, was involved with or participated in the copying of the document. Also, the person who copied this document from telephone company computers placed a copy on a bulletin board run by Rich Andrews. Andrews forwarded a copy to AT&T officials and cooperated with authorities fully. In return, the Secret Service (SS) confiscated Andrews' computer along with all the mail and data that were on it. Andrews was not charged with any crime. FREE PRESS: In another incident that would be comical if it were not true, on March 1 the SS ransacked the offices of Steve Jackson Games (SJG); irreparably damaged property; and confiscated three computers, two laser printers, several hard disks, and many boxes of paper and floppy disks. The target of the SS operation was to seize all copies of a game of fiction called GURPS Cyberpunk. The Cyberpunk game contains fictitious break-ins in a futuristic world, with no technical information of actual use with real computers, nor is it played on computers. The SS never filed any charges against SJG but still refused to return confiscated property. PEACEABLE ASSEMBLY: The right to assemble peaceably is no longer free -- you have to get a permit. Even that is not enough; some officials have to be sued before they realize their reasons for denying a permit are not Constitutional. PEACEABLE ASSEMBLY: In Alexandria, Virginia, there is a law that prohibits people from loitering for more than seven minutes and exchanging small objects. Punishment is two years in jail. Consider the scene in jail: "What'd you do?" "I was waiting at a bus stop and gave a guy a cigarette." This is not an impossible occurrence: In Pittsburgh, Eugene Tyler, 15, has been ordered away from bus stops by police officers. Sherman Jones, also 15, was accosted with a police officer's hands around his neck after putting the last bit of pizza crust into his mouth. The police suspected him of hiding drugs. PETITION FOR REDRESS OF GRIEVANCES: Rounding out the attacks on the first amendment, there is a sword hanging over the right to petition for redress of grievances. House Resolution 4079, the National Drug and Crime Emergency Act, tries to "modify" the right to habeas corpus. It sets time limits on the right of people in custody to petition for redress and also limits the courts in which such an appeal may be heard. Amendment II A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed. RIGHT TO BEAR ARMS: This amendment is so commonly challenged that the movement has its own name: gun control. Legislation banning various types of weapons is supported with the claim that the weapons are not for "legitimate" sporting purposes. This is a perversion of the right to bear arms for two reasons. First, the basis of freedom is not that permission to do legitimate things is granted to the people, but rather that the government is empowered to do a limited number of legitimate things -- everything else people are free to do; they do not need to justify their choices. Second, should the need for defense arise, it will not be hordes of deer that the security of a free state needs to be defended from. Defense would be needed against humans, whether external invaders or internal oppressors. It is an unfortunate fact of life that the guns that would be needed to defend the security of a state are guns to attack people, not guns for sporting purposes. Firearms regulations also empower local officials, such as police chiefs, to grant or deny permits. This results in towns where only friends of people in the right places are granted permits, or towns where women are generally denied the right to carry a weapon for self-defense. Amendment III No Soldier shall, in time of peace be quartered in any house, without the consent of the Owner, nor in time of war, but in a manner to be prescribed by law. QUARTERING SOLDIERS: This amendment is fairly clean so far, but it is not entirely safe. Recently, 200 troops in camouflage dress with M-16s and helicopters swept through Kings Ridge National Forest in Humboldt County, California. In the process of searching for marijuana plants for four days, soldiers assaulted people on private land with M-16s and barred them from their own property. This might not be a direct hit on the third amendment, but the disregard for private property is uncomfortably close. Amendment IV The right of the people to be secure in their persons, houses, papers and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized. RIGHT TO BE SECURE IN PERSONS, HOUSES, PAPERS AND EFFECTS AGAINST UNREASONABLE SEARCHES AND SEIZURES: The RICO law is making a mockery of the right to be secure from seizure. Entire stores of books or videotapes have been confiscated based upon the presence of some sexually explicit items. Bars, restaurants, or houses are taken from the owners because employees or tenants sold drugs. In Volusia County, Florida, Sheriff Robert Vogel and his officers stop automobiles for contrived violations. If large amounts of cash are found, the police confiscate it on the PRESUMPTION that it is drug money -- even if there is no other evidence and no charges are filed against the car's occupants. The victims can get their money back only if they prove the money was obtained legally. One couple got their money back by proving it was an insurance settlement. Two other men who tried to get their two thousand dollars back were denied by the Florida courts. RIGHT TO BE SECURE IN PERSONS, HOUSES, PAPERS AND EFFECTS AGAINST UNREASONABLE SEARCHES AND SEIZURES: A new law goes into effect in Oklahoma on January 1, 1991. All property, real and personal, is taxable, and citizens are required to list all their personal property for tax assessors, including household furniture, gold and silver plate, musical instruments, watches, jewelry, and personal, private, or professional libraries. If a citizen refuses to list their property or is suspected of not listing something, the law directs the assessor to visit and enter the premises, getting a search warrant if necessary. Being required to tell the state everything you own is not being secure in one's home and effects. NO WARRANTS SHALL ISSUE, BUT UPON PROBABLE CAUSE, SUPPORTED BY OATH OR AFFIRMATION: As a supporting oath or affirmation, reports of anonymous informants are accepted. This practice has been condoned by the Supreme Court. PARTICULARLY DESCRIBING THE PLACE TO BE SEARCHED AND PERSONS OR THINGS TO BE SEIZED: Today's warrants do not particularly describe the things to be seized -- they list things that might be present. For example, if police are making a drug raid, they will list weapons as things to be searched for and seized. This is done not because the police know of any weapons and can particularly describe them, but because they allege people with drugs often have weapons. Both of the above apply to the warrant the Hudson, New Hampshire, police used when they broke down Bruce Lavoie's door at 5 a.m. with guns drawn and shot and killed him. The warrant claimed information from an anonymous informant, and it said, among other things, that guns were to be seized. The mention of guns in the warrant was used as reason to enter with guns drawn. Bruce Lavoie had no guns. Bruce Lavoie was not secure from unreasonable search and seizure -- nor is anybody else. Other infringements on the fourth amendment include roadblocks and the Boston Police detention of people based on colors they are wearing (supposedly indicating gang membership). And in Pittsburgh again, Eugene Tyler was once searched because he was wearing sweat pants and a plaid shirt -- police told him they heard many drug dealers at that time were wearing sweat pants and plaid shirts. Amendment V No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject to the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use without just compensation. INDICTMENT OF A GRAND JURY: Kevin Bjornson has been proprietor of Hydro-Tech for nearly a decade and is a leading authority on hydroponic technology and cultivation. On October 26, 1989, both locations of Hydro-Tech were raided by the Drug Enforcement Administration. National Drug Control Policy Director William Bennett has declared that some indoor lighting and hydroponic equipment is purchased by marijuana growers, so retailers and wholesalers of such equipment are drug profiteers and co-conspirators. Bjornson was not charged with any crime, nor subpoenaed, issued a warrant, or arrested. No illegal substances were found on his premises. Federal officials were unable to convince grand juries to indict Bjornson. By February, they had called scores of witnesses and recalled many two or three times, but none of the grand juries they convened decided there was reason to criminally prosecute Bjornson. In spite of that, as of March, his bank accounts were still frozen and none of the inventories or records had been returned. Grand juries refused to indict Bjornson, but the government is still penalizing him. TWICE PUT IN JEOPARDY OF LIFE OR LIMB: Members of the McMartin family in California have been tried two or three times for child abuse. Anthony Barnaby was tried for murder (without evidence linking him to the crime) three times before New Hampshire let him go. COMPELLED TO BE A WITNESS AGAINST HIMSELF: Oliver North was forced to testify against himself. Congress granted him immunity from having anything he said to them being used as evidence against him, and then they required him to talk. After he did so, what he said was used to find other evidence which was used against him. The courts also play games where you can be required to testify against yourself if you testify at all. COMPELLED TO BE A WITNESS AGAINST HIMSELF: In the New York Central Park assault case, three people were found guilty of assault. But there was no physical evidence linking them to the crime; semen did not match any of the defendants. The only evidence the state had was confessions. To obt f:\12000 essays\health & humanities (196)\Ambulatory Cancer Treatments.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ I. Cancer is a group of diseases characterized by an uncontrolled growth of abnormal cells. If the spread of these abnormal cells is not controlled, cancer can cause death. Most cancers take the form of tumors, although not all tumors are cancers. A tumor is simply a mass of new tissue that serves no physiological purpose. It can be benign, like a wart, or malignant, like cancer. Benign tumors are made up of cells similar to the surrounding normal cells and are enclosed in a membrane that prevents them from penetrating neighboring tissues. They are dangerous only if their physical presence interferes with bodily functions. A malignant tumor, or cancer, is capable of invading surrounding structures, including blood vessels, the lymph system and nerves. It can also spread to distant sites by the blood and lymphatic circulation and so can produce invasive tumors in almost any part of the body. In 1997, an estimated 1,359,150 people in the United States will be diagnosed with cancer and 554,740 will die of the disease. Early screening for cancer is believed to be able to drastically reduce the number of deaths due to the disease. Knowing what to look for when detecting cancer, as well as knowing if you are in a high risk population are two of the main factors of early intervention. Early intervention of cancer has proven to increase survival rates and lower the length and severity of treatments. Detection and protection are two types of ambulatory care for cancer that begin before the disease is ever diagnosed. II. Cancer often causes symptoms that you can watch for. These include: change in bowel or bladder habits; a sore that does not heal; unusual bleeding or discharge; thickening or lump in page 2 the breast or any other part of the body; indigestion or difficulty swallowing; obvious change in a wart or mole; and nagging cough or hoarseness. These symptoms are not always warning signs of cancer. They can also be caused by less serious conditions. It is important to see a doctor if any of these symptoms occur. Only a doctor can make a diagnosis. A person shouldn't wait to feel pain because early cancer usually does not cause pain. Observation is the most widely available examination for the detection of cancer. It is useful in identifying suspicious lesions in the skin, lip, mouth, larynx, external genitalia and cervix. The second most available detection procedure is palpation. It is particularly valuable in detecting lumps, nodules, or tumors in the breast, mouth, salivary glands, thyroid, subcutaneous tissues, anus, rectum, prostate, testes, ovaries and uterus and enlarged lymph nodes in the neck, axilla or groin. Internal cancers require an extension of observation through endoscopes, x-rays, magnetic resonance imaging, and ultrasound. Laboratory test, such as the Pap smear, and occult blood testing of the feces have also proven helpful for some of the cancers. However, concerns regarding effectiveness and yield play a particularly important role in decisions to screen for cancers not easily responsive to earlier detection through physical examination. The performance of these tests is usually measured in terms of sensitivity, specificity, and positive and negative predictive values. The type, periodicity, and commencement of screening in high-risk populations for most cancers reflect the judgment of expert practitioners rather that evidence from scientifically- conducted test. Some individuals are known to be at high risk for cancer, such as those with a strong family history of cancer. Physician judgment is needed in such circumstances to page 3 determine the most appropriate application of available screening methods. Once the high-risk person is identified, is counseled appropriately, and regularly undergoes screening procedures, the benefits of early detection and treatment are available to this person, yielding a proven higher chance of recovery. Those people considered high risk should take extra precautions when attempting to detect cancer. III. Important facts that a person should know about how to protect against getting cancer include: not using tobacco products; eating at least five servings of fruits and vegetables each day; if you are a woman, getting a mammogram, pelvic exam and Pap test every year; getting tests done as you get older for cancers of the colon and rectum; if you are a man, getting early detection tests for prostate cancer, avoiding too much sunlight by wearing protective clothing and sun screen; and avoiding unnecessary x-rays. If a person does have cancer, it is wise to find out what the treatment choices are and which are best suited for that person. Before getting treatment, it is advisable to get a second opinion from another doctor. These are all forms of protection that can be done by an ambulatory basis. IV. Four basic forms of treatment for cancer are currently practiced. These are surgery, radiation therapy, biological therapy and chemotherapy. All but surgery can be performed on an outpatient basis. The physician may use one form of therapy or a number of different forms in order to produce the desired results. page 4 A. Radiation therapy is one of the major ambulatory treatment modalities for cancer. Approximately 60% of all people with cancer will be treated with radiation therapy sometime during the course of their disease. Its effectiveness as a treatment for cancer was first reported in the late 1800s. Advances in equipment technology, combined with the science of radiobiology, have led to today's highly sophisticated treatment centers. Radiation therapy can now be delivered with maximum therapeutic benefits, minimizing toxicity and sparing healthy tissues. Radiation therapy uses high-energy ionizing radiation to kill cancer cells. It is considered a local therapy because the cancer cells are destroyed only in the anatomical area being treated. The radiation causes a breakage of one or both stands of the DNA molecule inside the cells, therefor preventing their ability to grow and divide. While cells in all phases of the cell cycle can be damaged by radiation, the lethal effect of radiation may not be apparent until after one or more cell divisions have occurred. Although normal cells can also be affected by ionizing radiation, they are usually better able to repair their DNA damage. Radiation treatments can be administered externally or internally, depending on the type and extent of the tumor, however only external radiation can be administered in an out-patient basis. Some patients have both forms, one after the other. X-rays, radioactive elements, and radioactive isotopes are most often used in these forms of treatment. External radiation treatments are administered by machines that deliver high-energy radiation. These machines vary according to the amount and type of energy produced. The kind of machine will differ depending on the type and extent of the tumor. Technological advances have permitted the development of machines with increased energy, allowing for precise page 5 treatments of deep seated tumors with less damage to superficial tissues. Treatment of cancer with radiation can be costly. It requires very complex equipment and the service of many health care professionals. The exact cost of the radiation therapy will depend of the type and number of treatments given. Most health insurance policies cover charges for radiation therapy, and in some states the Medicaid program may help pay for the treatments. The side effects of radiation treatment vary from patient to patient. Some may have no side effect or only a few mild ones through the course of treatment. Some may have more serious side effects. The side effects one has depends mostly on the treatment dose and the part of the body that is treated. There are two main types of side effects: acute and chronic. Acute occurs close to the time of the treatment and usually are gone completely within a few weeks of finishing therapy. Chronic side effects may take months or years to develop and are usually permanent. The most common side effects are fatigue, skin changes, and loss of appetite. The can result from radiation to any treatment site. Other side effects are related to treatment of specific areas, such as hair loss as a result of radiation treatment to the head. The majority of side effects will go away in time. B. Biological therapy (sometimes called immunotherapy, biotherapy, or biological response modified therapy) is a promising new addition to the family of cancer treatments. Biological therapies use the body's immune system, either directly or indirectly, to fight cancer or to lessen side effects that may be caused by some cancer treatments. page 6 The body has a natural ability to protect itself against diseases, including cancer. The immune system, a complex network of cells and organs that work together to defend the body against attacks by foreign invaders, is one of the body's main defenses against disease. Researchers have found that the immune system may recognize the difference between healthy cells and cancer cells in the body and eliminate those that become cancerous. Cancer may develop when the immune system breaks down or is overwhelmed. Biological therapies are designed to repair, stimulate or enhance the immune system's natural anticancer function. Immune system cells and proteins called antibodies, which are part of the immune system, work against cancer and other diseases by creating an immune response against foreign invaders. This immune response is unique because antibodies are specifically programmed to recognize and defend against certain antigens. Antibodies respond to antigens by latching on to them. Biological therapies used to treat cancer target some of the defenses by boosting, directing or restoring the body's own cancer-fighting mechanisms. C. Chemotherapy is the use of medications or chemicals with cancer-fighting abilities. Chemotherapy drugs interfere with the cancer cells' ability to grow or multiply. Different groups of drugs act on cells in different ways. Identification of the type of disease is important because certain chemotherapies work best for certain diseases. Even patients diagnosed with the same disease may be treated with different agents, depending on what is known to be most effective for the particular circumstances. Chemotherapy can damage normal cells as well as cancer cells. Those normal cells most effected are ones which divide rapidly. These include the hair follicles, cells in the gastrointestinal tract and bone marrow. page 7 Chemotherapy can be given in different ways. The five most common methods are: intravenous, oral, intramuscular, intrathecal and intraperitoneal. The intravenous route, or IV, is a very common way of giving medication directly into a vein. A small plastic needle is inserted into one of the veins in the lower arm. There is some discomfort during insertion because a needle stick is required to get into the vein. After that, the administration of the medication is usually painless. Chemotherapy flows from the IV bag through the needle and catheter into the bloodstream. Sometimes a syringe is used to push the chemotherapy through the tubing. The oral method takes the form of either a pill, capsule or liquid taken by mouth. This is the easiest and most convenient method and can usually be done at home. Intramuscular is when the chemotherapy is given by way of an injection into the muscle. There is a slight sing as the needle is placed into the muscle of the arm, thigh or buttocks. Although this procedure lasts only a few seconds, the effect of the intramuscular chemotherapy may last much longer. This is because the chemotherapy may be absorbed slowly through the muscular tissues and into the bloodstream. Certain forms of cancer have a tendency to spread to the nervous system. To treat cancer that spreads to the spinal cord or brain, doctors may perform a spinal tap and inject chemotherapy into the spinal fluid. The is known as the intrathecal method of administration of chemotherapy. Chemotherapy may also be given by an intraperitoneal port. This device sits under the skin and requires no specific home care. The port allows for placing chemotherapy directly into the abdominal cavity. This technique is used to increase the concentration of the chemotherapy page 8 that contacts tumors in the abdomen. For some patients, IV insertions can eventually damage the veins in the arm. Some patients have small veins and some have very few accessible veins. Frequent IV insertions and too small or too few veins may prompt the doctor to recommend a permanent type of IV catheter. Permanent catheters allow patients to go home and receive chemotherapy without needing other IV's placed. Along with receiving chemotherapy and IV fluids through this catheter, patients can receive blood products and even have their blood drawn without painful needle sticks. Chemotherapy may be given once a day, once a week, or even once a month, depending on the type of cancer and what research has shown is the best time period for treatment. How much chemotherapy costs will depend on a lot of things, such as the kind of drugs used and how often you take them. Some medical insurance pays for chemotherapy and government programs such as Medicare and Medicaid can also help cover the costs. Side effects of chemotherapy vary from each patient. Some patients take chemotherapy and feel no changes at all. However, chemotherapy sometimes makes you feel sick after the drugs get into the body. This is because very strong drugs are being used. They go after any cell that is quickly dividing, whether it is a cancer cell or not. Cells in the hair, bone marrow, skin, mouth, and in the stomach normally divide quickly in the body. This is why the side effects of chemotherapy can mean hair loss or feeling tired. Sores in the mouth, dry skin and hair, or sickness to the stomach are also common side effects of chemotherapy. There are some medications that a person can take that could help get rid of some of the side effects. There are few lasting problems, and unpleasant symptoms often go away as soon as the treatment is finished. page 9 Chemotherapy might be taken before or after surgery. Or, it could be administered with radiation treatment. Some people also have chemotherapy without surgery or radiation. Chemotherapy is not new. It has been helping people since the early 1950s. Today it can be very effective in killing cancer cells. V. Cancer is a very serious disease, and is one which many people fear. Ambulatory treatment for cancer can be done in several different ways, but the most effective kinds of ambulatory care for cancer is prevention and early detection. This way, it is possible that a person will not have to undergo cancer treatments. However, if cancer is diagnosed in a person, ambulatory treatment options are available in attempts to rid the body of the cancer. With this in mind, today's cancer patients and those with a high-risk potential for acquiring cancer, will have many options available to them to manage the disease. f:\12000 essays\health & humanities (196)\Amyotrophic Lateral Sclrosis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Amyotrophic Lateral Sclerosis Motor Neuron Disease Maladie de Charcot Lou Gehrig's Disease What is the Disease? ALS is an extremely deadly disease affecting the nerve cells that control the victim's voluntary muscles. These nerves shrink and eventually die, leaving the muscles without stimulation. As these muscles go without stimulation, they too eventually shrink and die. The victim progressively weakens to the point of complete paralysis of all voluntary muscles and some involuntary muscles, such as breathing and swallowing, and soon after this point, death is inevitable. 'A' means "Without" 'Myo' means "Muscle" 'Trophic' means "Nourishment" 'Lateral' refers to uneven development of symptoms between right and left sides 'Sclerosis' refers to "destruction" of tissue The History of ALS A French doctor named Charcot first identified ALS in 1874. It is one of the most devastating diagnoses a person can receive. ALS is said to start between the years of 40 and 70, with the exact average being 45.6 years old. The most classic case of Amyotrophic Lateral Sclerosis is Lou Gehrig. Lou Gehrig was a New York Yankees first baseman, who from 1923 to 1939, had never missed a game and had a life time batting average of .340. However, the symptoms of ALS emerged in 1938, and in 1939, he was diagnosed with the disease. At that time doctors knew little to nothing about the disease and the only suggested treatment was the untested vitamin E. So Gehrig ate a daily plate full of garden grass, until June 2, 1941 when he died at the age of 37. ALS affects approximately 1 out of every 100,000 people. In the United States there are around 30,000 Americans affected by ALS, and 3,000 more are diagnosed with the disease each year, with men being affected slightly more than women, and in some cases, running in families. However while this is the same number of new cases as Multiple Sclerosis, Multiple Sclerosis affects around 350,000 Americans. The difference is that 50% of ALS patient's die within three years, and 80% die within five. The disease is in some ways quite similar to Alzheimer's except with Alzheimer's you have a body walking around with a diseased brain, whereas with ALS you have a healthy brain trapped inside a diseased body. Symptoms About one-third of those with ALS become aware of their disease when their hands become clumsy, causing difficulty performing anything needing fine finger movements. Another third find a weakness in their legs and may trip because of a mild foot drop. The remaining one-third notice slurring in their speech or difficulty swallowing. Because all of these symptoms happen naturally, it is generally not characterized as ALS until the symptom progressively worsens. This happens as the affected area's muscle cells deteriorate, resulting in muscle tenseness. Frequently one side of the body is affected first and it then gradually passes to the other side. Muscles in the eyes, anus and bladder are generally left unaffected. Diagnoses As there is no known way to prevent this disease, there is also no specific clinical test to identify ALS. It generally involves a physical examination, perusing through the patient's medical history, and neurological testing. To test muscle activity specialists often use an EMG, or electromyogram, and will often use CT scans, MRIs, and thorough blood examination. There is also a recently developed SOD1 scan, the gene now thought to be the cause for ALS, especially familial ALS. Only 20%, however, of patients with familial ALS show positive on the SOD1 scan. Progress of ALS Until very recently very little was known about ALS, either what started it or how to treat it. Currently there are 3 types of ALS: classic (sporadic), familial, and the Mariana Island. Classic ALS accounts for 90-95% of ALS patients in the U.S. The infrequent familial form (FALS) is inherited and if your parents had FALS there is a 50/50 chance you will have it as well. The Mariana Island form is a rare form of ALS found in patients taken from Guam and Japan. ALS appears evenly across the globe except in the Mariana Islands in the West Pacific and the Kii Peninsula of Japan where it is unusually high. Back during Gehrig's time little else besides vitamin E was even considered a "potential" therapy, and there were only guesses as to the cause of the disease until 1991 when evidence linked FALS to chromosome 21. Then in 1993 the same research team identified a defective SOD1 gene on chromosome 21 as being responsible. It is now known that structural defects in the Super Oxide Dismutase, or SOD, enzyme reduces the ability to protect against damage to motor neurons. Treatment Traditionally doctors were unable to subscribe anything other than a good source of Vitamin E, exercise and a healthy mind. However, in June of 1996 the Food and Drug Administration passed the first drug for ALS. The drug Riluzole was successful in lengthening the life-time of ALS patients, especially those with FALS. However, there is still no way to dampen the symptoms or prevent those who don't have it, from getting it. This still was a big step for ALS and there are now 21 countries that have approved Riluzole, including the Czech Republic and all 15 members of the European Union. Gabapentin is also similar to Riluzole and is being tested for approval by the FDA. More importantly, a drug known as Myotrophin is being tested as well by the FDA and may be the first drug to slow the progress of paralysis. Because Myotrophin acts differently than Riluzole, they, hopefully, can be used in synch as well. Rescources Science News, Vol. 145, page 202 The Sacramento Bee, March 2, 1994, A8 The Sacramento Bee, June 9, 1996 The Wall Street Journal, June 13, 1995, B7 Applied Medical Informatics (AMI), 1994 Muscular Dystrophy Association (MDA), January 31, 1996 The New York Times, May 9, 1995 The New York Times, June 13, 1995 Gene Therapy, March 1995 Mayo Clinic Health Letter, April 1996, page 5 Rhone-Poulenc Rorer, August 1995 The ALS Association and the Neuromuscular Research Foundation Internet Sites: http://www.caregiver.org/fs/fs_als.html http://www.medicinenet.com/ http://www.phoenix.net/~jacobson/guide2.html http://www.familyvillage.wisc.edu/lib_als.htm f:\12000 essays\health & humanities (196)\An Easier Way Out.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ An Easier Way Out Doctor Kevorkian and other so-called "death doctors" should be permitted to assist in the premature deaths of the terminally ill. Although many states outlaw assisted suicides, nevertheless, they should by made legal for terminally ill patients. These patients may not want to suffer a long, painful death. The terminally ill will not get well, they might decide to make the decision of ending their life alone if they cannot receive proper help, and assisted suicides may one day be useful in discovering how the human brain works or perhaps find a cure to some fatal diseases. First, the terminally ill patients will not get better or become cured of the disease they have. According to many medical physicians the expression "terminally ill" means being in the final stages of a disease that is incurable (Hentoff, p.10). If a person has a despairing disease such as AIDS, that person may not want to live the rest of their short life with all the pain and frustration. Next, the terminally ill might injure their body even more by taking up the decision in their own hands. Offering help in assisted suicides to the fatally ill would prevent anything like this from happening. The Second Circuit Court of Appeals created a law that prohibited physicians from helping their patients die (Lemonick, p.82). Now, patients who are terminally ill and who wish to die might decide to kill themselves in a manner that is less humane than with a lethal injection or dosage of medicine. This new law makes it much harder to get proper help in attaining an assisted suicide. This clearly would cause many more problems than it would do good. Last, there are many ways that using terminally ill patients that can benefit science and the medical fields. Doctor Kevorkian has been advancing a proposal to allow condemned criminals and terminally ill patients to perform tests on their brains while they are still alive and willingly know they will die soon afterward. Kevorkian claims that these human experiments allow us to fully understand how the human body functions. He also proposed to allow the criminals who are condemned to donate their organs for transplant. (Hosenball, p.28-29). Through studying on live humans we would gain a much greater understanding of ourselves and possibly discover some new medicinal drugs. The terminally ill will not recover from their disease, they might decide to unlawfully take their own life and possibly get hurt severely in the process, and the experimentation on certain criminals and mortally ill patients would aid in the development of new drugs. Allowing assisted suicides in our country would be a great asset and opportunity for people who will not recover to end all the suffering. The legalization of assisted suicides would prevent many accidents from occurring such as people committing the act of suicide and being unsuccessful. Legalizing aided suicides would also prevent people from killing themselves illegally. With all of the technological advances in our community today the legalization of aided suicides is a must. For the sake of all humanity and virtue in our society today, exercise your freedom of choice and look at assisted suicides with a different, but, moral perspective. Works Cited Hentoff, Nat. "From Assisted Suicides to Euthanasia." Village Voice 14 May 1996: p. 10 Hosenball, Mark. "The Real Jack Kevorkian." Newsweek 6 Dec. 1996: p. 28-29 Lemonick, Michael. "Defining the Right to Die." Time 15 Apr. 1996: p. 82 f:\12000 essays\health & humanities (196)\Analysis of Scared to Death of Dying Article by Herbert He.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Jose Delgado February 24, 1997 English 102 Mr. Vegh Analysis of "Scared to Death of Dying", Article by Herbert Hendin The background for this work is that the existing conflict over legalizing assisted suicides and euthanasia could bring our values down and society apart. The problem is not legalizing or opposing to it, the real problem is to find a way to care for the terminally ill. We have the responsibility to help the terminally ill die in a decent way not killing them. If we don't have a policy or rule against this we are permitting doctors, like Jack Kevorkian, to become famous for killing people. The claim for this work is that assisted suicides and euthanasia should be illegal. The Oregon Law would allow people to die quicker and without dignity. We can see that this is true in the story of the 30 year-old man that has leukemia. He had a 25 percent chance of survival if he was medically treated; if not he was given a few months to live. When told this, the man wanted to suicide. At first he was scared but after talking with the doctor he decided to take medical treatment and be closer to his family in his final days. If this had happened under the Oregon Law, he would have asked a doctor to assist him in suicide and the doctor would have assisted him without any problem since he had no mental illness. Doctors can cause or hastened death without the patient's request. This can be seen in the Netherlands were a 30 year-old man who was H.I.V.-positive, but had no symptoms and may not develop them for years, was helped to die. Probably the doctors didn't explain that even if he had a terminal disease he could enjoy the rest of his life with his family and friend that were about to lose him. Doctors aren't trained to do this in medical school and the public doesn't know better. This is because doctors aren' t trained properly in the relief of pain and discomfort in terminally ill patients. And time should be devoted in medical schools to explain to the future doctors that there are going to be some patients that they are not going to be able to save but must address their needs. Also the public hasn't been properly educated about the choices they have at the end of their life. The purpose of this work is to create a national commission that would study the care of the terminally ill giving treatment to the dying patients. Both people who support and oppose euthanasia will be able to participate having in mind that the real problem is the care for the terminally ill. This will help the people to make up their minds and arrive at a consensus. This work was written for a neutral but mature audience. This work was printed in the New York Times and deals with an important issue that some people may not understand. The language of the work is not confusing. The issue seen in the argument is complicated and may not be suitable for everybody. People must understand the problem before judging on it. This work has a proposal argument since it talks about making a commission to deal with the legalization problem of euthanasia and assisted suicide. This commission would be in charge of finding solutions for the problem of the care of terminally ill patients and not the legalization of assisted suicides or euthanasia. This commission would help people understand the problem the legalization of euthanasia would bring to our nation. f:\12000 essays\health & humanities (196)\ANGER MANAGEMENT AND HEALTH.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ANGER MANAGEMENT AND HEALTH by, Danita C. McCoy Anger Management and Conflict Dr. Daube, Instructor November 6, 1996 Everybody feels anger from time to time. People have been documented feeling anger since biblical times when God was considered angry. Babies even exhibit signs that are interpreted as anger, such as crying or screaming. Anger is not in any way unique to people. Animals also have the ability to feel and express anger. In our personal lives we get angry over at least one thing on almost a daily basis, whether it be on the job, with a spouse or loved one, or perhaps with a figure of authority. Many psychologists have written about anger, discussing the relationship between anger and fear. Each of the individuals that comprise humanity possesses at least one phobia, in the same way that each is capable of possessing anger. The negativity that is associated with phobias often spills over into our feelings about anger. We begin to think negatively about anger since we associate it with fear. Plato was the first to suggest that anger was a disbalance. According to Dr. Willard Gaylin, a prominent psychologist, anger is still seen as a disbalance by many of today's psychologists. Since Plato, anger has suffered a bad reputation. We only have to imagine a domestic abuse scene to immediately condemn anger in all of its manifestations. There is a reason why anger is viewed in a negative light. Nobody likes it when someone is angry with them. We tend to avoid the wrath of those around us. This is one reason we see anger as negative. Another reason may lie closer to Plato's concept of imbalance. The negative perception of anger is evident in the American Heritage Dictionary's definitions of the word anger (1): 1. A feeling of extreme displeasure, hostility, indignation, or someone or something; rage; wrath; ire. 2. (Obsolete) Trouble; pain; affliction. To say, "I'm getting angry", is to invoke fear in another, usually, that fear originates from a perception that the utterer of the phrase is about to take some sort of dramatic action. Dr. Gaylin speaks for these emotions, rage is a response to a perceived assault that effects the body in interesting ways. Skeletal muscles are tensed; the autonomic system moves to increase the supply of adrenaline and redistribute the blood flow of the body; certain muscles are contracted and opposing ones relaxed. (2) Apparently, anger is viewed negatively for a reason that is closer to Plato's concept of imbalance. It is also closer to the American Heritage's definition of being sick. The authors of When Anger Hurts: Anger in Modern Life explain the complications that chronic anger can create. Doctors have long suspected that anger increases the blood rate. Many scientists now point out that norepinepherine, the drug that is secreted during anger, increases blood pressure as well. Anger and abnormally high blood pressure are correlated; and high blood pressure leads to many forms of heart disease. In a recent study 1,623 patients were interviewed an average of four days after they had suffered a heart attack following an outburst of anger. The study showed that the risk of suffering a heart attack is doubled after an outburst of anger. (3) The psychologist Franz Alexander's hypothesized in 1839 that hypertesnisves lack basic assertive skills. Psychological studies have repeatedly backed Alexander's assertion theory ever since. (4) High blood pressure is said to be caused by uncontrolled anger, which in turn is caused by a lack of assertion. If we bottle up our anger now, then we will feel it later. Eventually our arteries will grow weak and we will remain tense, living daily with treacherous moods and health. The alternative is to shout out our anger at the world and let it manifest itself any way that it pleases. Of course, taking our anger out at the world can have even more deleterious effects. People just don't like it when we demonstrate our anger. Many of us are taught at an early age to bury our anger inside, where it causes stress, both emotionally and physically. For example, in grade school, children have to stay after class or are sent to the principle when they express feelings of anger. Poorly managed anger is the cause of many serious physical, social and emotional problems, form heart disease to neighborhood violence. The Institute for Mental Health Initiatives (IMHI) believes that by teaching people the skills to manage their anger constructively, they will become empowered with the ability to understand their own and other's feelings and resolve conflict in a non-violent manner. The IMHI believes the best way to achieve this goal is to train teachers, counselors, social workers, health professional, community leaders and others in constructive anger management skills so that they can help others by conducting workshops in their own settings. (3) Anger is not physically healthy. Bottled up, it can lead to drug-induced escapism or to ignorance of our surroundings. Venting anger carelessly can also be dangerous. It is no wonder that anger has been viewed as negative. Since we live in a stressful society, we have no choice but to find ways of venting anger positively. East Asian religion has given the West meditation, which is known to slow the heartbeat and calm the nerves. Other Eastern techniques of reducing stress include acupuncture, and the Japanese bathhouse. In the United States we have psychology, also, a number of exercises have been developed to control and eventually reduce stress and anger. One basic technique is called deep breathing: Lie down on your back, placing one hand on your chest and another on your abdomen. Take deep breaths, inhaling slowly through the nose. Feel the abdomen raise and scan the body for tension. Let the tension go as you encounter it. After five to ten minutes the body is less tense. It is suggested that this exercise be done once or twice a day for two to three weeks to get useful results. (4) Redford Williams, a professor of psychiatry at Duke University Medical Center and co-author of Anger Kills, has spent more than 20 years studying the impact of the mind and emotions on health. Dr. Williams believes that when normal people are faced with everyday anger, annoyance, irritation, and frustration- and their immediate impulse is to commonly blame somebody or something, sparking fury toward the offender manifesting itself in aggressive action, then getting angry is like taking a small dose of slow-acting poison. According to a study of more than 1,000 people at a Western Electric Factory in Chicago, over a 25 year period, those with high hostility scores were at high risk of dying from coronary disease as well as cancer. There is evidence that the immune system may be weaker in hostile people, according to Dr. Williams. Long-term anger with no forgiveness is deadly. Long term anger can lead to carrying a grudge, which in turn hurts the person harboring the grudge more than the person or object whom the grudge is directed. Hostility can also lead to heart disease and other life-threatening illnesses. (3) Of course, if a particular issue is a thorn in one's side, it may be best to lash out at the threat. Wisdom is knowing when to lash out. Meditation and its cousin, deep breathing are two methods of contemplation, which Albert Bernstein, the author of Dinosaur Brains, calls using the cortex. If we are aware of the oncoming anger, we can vent it positively with these tools. If we are unconscious that we are angry, then there is no way of controlling our externalization of the anger. Albert Bernstein also describes how our brains are constructed quite a bit like those of dinosaurs. We conceptualize more abstract threats such as a coworker moving in on our territory. (5) This sort of anger seems frivolous, but exists because we view reality the way we want. We perceive what is not truly harmful as threatening. Unfortunately, we are too often unconscious of our own anger. Dr. Hendrie Weisinger, in his book Anger at Work, explains that people often have powerful emotional reactions to others, yet are at a loss to explain just why they respond as they did. Plenty of thinking goes on low frequency... an almost subconscious level. (6) Regardless of how we may try to be rational, we detect subtle indicators of our peers' moods. We often react to people based on these subtle indicators that we receive of them. If we ignore the fact that much of our emotion originates from this unconsciousness, then we cannot control it via our more rational cortex. Relaxation techniques allow our brain to process emotions, so that we can deal with them consciously. Dr. Weisinger also recommends that people outthink anger by watching our for it. Otherwise, we will blow up anger in our own mind, magnifying the significance of negative events. This can lead to misdirected anger. For many individuals, anger is a particularly strong influence, and it is difficult to control it even when it is conscious anger. If any form of relaxation doesn't work, they should try removing themselves from the stressful situation before they get an adrenaline rush or their heart beat rises. As previously stated, anger is mostly seen as an affliction rather than a remedy. But, is anger positive?: The answer to the question is a conditional yes. Indeed, anger is positive when it is used to assert oneself. When one is being threatened by an adversary, anger can actually be useful. Our bodies are designed to make us feel bigger than life at the sign of threat or provocation. The area of the brain called the amygdala mediates anger experiences, judging events as either aversive or rewarding. A threat code triggers a two-stage fight/flight mobilization in the body. Things that affect our bodily state can make us more emotionally reactive. When Anger Hurts: Quieting the Storm Within documents a situation in which anger can be positive, the authors describe a beneficial use of anger (4): "Iris, a middle-aged woman living in New York, heard footsteps following her as she was returning home alone. She was frightened but then she became angry at the thought of being victimized. She slowed down; when the footsteps came nearer, she whirled around and shouted at the top of her voice, 'Get away from me you son-of-a-bitch or I'll kill you!' The would-be attacker fled." In this case, anger helped in the instance of physical attack. Anger can also be beneficial when one's boundaries are violated. (2) If someone is pushing you to the limit, there must come a point in which you can assert yourself. Without such assertion, others will begin to make excessive demands on you. People that follow that pattern and constantly give into others' demands are told that they need to be more assertive. Anger fosters this self assertion and it helps us display that assertion. So it appears that we are faced with choosing between two evils. On one hand, we can lash out at the world, thereby hurting others, or we can bottle in our anger, thereby hurting ourselves. Anger in all of its manifestations appears to be negative, with few exceptions, such as the woman that hinders an attack by using anger to scare off the attacker. Anger does deserve all of its bad reputation. Anger can be very destructive, it can lead to liver, heart and artery damage. The key to living with anger is being conscious of the anger that is within us. Without such knowledge of ourselves, our anger will remain raw and unfiltered. Wisdom lies in knowing when to deny anger and when to vent it, when to direct it, and at what target. Leaving anger alone, leaving it to smolder so to speak, is a dubious method of coping with anger. Aristotle said it best centuries ago, "Anyone can become angry - that is easy. But to be angry at the right person, to the right degree, at the right time, for the right purpose, and in the right way - that is not so easy." (4) Chronic anger does lead to health problems. Not everyone suffers from anger, but for those that do, it means a multitude of emotional related illnesses. Anger is often accompanied by an imbalance of hormones, as Plato recognized, and no imbalance is healthy in the long run. With consciousness and relaxation, people may be able to achieve dominance over anger, rather than allowing it to have dominance over them. BIBLIOGRAPHY 1 American Heritage Dictionary Houghton Mifflin Company, Boston, MA 1985 2 Gaylin, Willard, M.D. The Anger Within: Anger in Modern Life. Simon and Schuster, New York, NY 1984 3 Internet Research: Coping with Anger, 1996 4 McKay, Rogers When Anger Hurts: Quieting the Storm Within. New Harbinger, Oakland, CA 1989 5 Bernstein and Rozen Dinosaur Brains: Dealing with all Those Impossible People at Work. John Wiley and Sons, New York, NY 1989 6 Weisinger, Hendrie, M.D. Anger at Work: Learning the Art of Anger Management on the Job. William Morrow and Comapny, New York, NY 1995 f:\12000 essays\health & humanities (196)\Angina Pectoris.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ANGINA PECTORIS Submitted by: Course: SBI OAO To: Date: CONTENTS 3 Introduction 4 The Human Heart 5 Symptoms of Coronary Heart Disease 5 Heart Attack 5 Sudden Death 5 Angina 6 Angina Pectoris 6 Signs and Symptoms 7 Different Forms of Angina 8 Causes of Angina 9 Atherosclerosis 9 Plaque 10 Lipoproteins 10 Lipoproteins and Atheroma 11 Risk Factors 11 Family History 11 Diabetes 11 Hypertension 11 Cholesterol 12 Smoking 12 Multiple Risk Factors 13 Diagnosis 14 Drug Treatment 14 Nitrates 14 Beta-blockers 15 Calcium antagonists 15 Other Medications 16 Surgery 16 Coronary Bypass Surgery 17 Angioplasty 18 Self-Help 20 Type-A Behaviour Pattern 21 Cardiac Rehab Program 22 Conclusion 23 Diagrams and Charts 26 Bibliography INTRODUCTION In today's society, people are gaining medical knowledge at quite a fast pace. Treatments, cures, and vaccines for various diseases and disorders are being developed constantly, and yet, coronary heart disease remains the number one killer in the world. The media today concentrates intensely on drug and alcohol abuse, homicides, AIDS and so on. What a lot of people are not realizing is that coronary heart disease actually accounts for about 80% of all sudden deaths. In fact, the number of deaths from heart disease approximately equals to the number of deaths from cancer, accidents, chronic lung disease, pneumonia and influenza, and others, COMBINED. One of the symptoms of coronary heart disease is angina pectoris. Unfortunately, a lot of people do not take it seriously, and thus not realizing that it may lead to other complications, and even death.THE HUMAN HEART In order to understand angina, one must know about our own heart. The human heart is a powerful muscle in the body which is worked the hardest. A double pump system, the heart consists of two pumps side by side, which pump blood to all parts of the body. Its steady beating maintains the flow of blood through the body day and night, year after year, non-stop from birth until death. The heart is a hollow, muscular organ slightly bigger than a person's clenched fist. It is located in the centre of the chest, under the breastbone above the sternum, but it is slanted slightly to the left, giving people the impression that their heart is on the left side of their chest. The heart is divided into two halves, which are further divided into four chambers: the left atrium and ventricle, and the right atrium and ventricle. Each chamber on one side is separated from the other by a valve, and it is the closure of these valves that produce the "lubb-dubb" sound so familiar to us. (see Fig. 1 - The Structure of the Heart) Like any other organs in our body, the heart needs a supply of blood and oxygen, and coronary arteries supply them. There are two main coronary arteries, the left coronary artery, and the right coronary artery. They branch off the main artery of the body, the aorta. The right coronary artery circles the right side and goes to the back of the heart. The left coronary artery further divides into the left circumflex and the left anterior descending artery. These two left arteries feed the front and the left side of the heart. The division of the left coronary artery is the reason why doctors usually refer to three main coronary arteries. (Fig. 2 - Coronary Arteries)SYMPTOMS OF CORONARY HEART DISEASE There are three main symptoms of coronary heart disease: Heart Attack, Sudden Death, and Angina. Heart Attack Heart attack occurs when a blood clot suddenly and completely blocks a diseased coronary artery, resulting in the death of the heart muscle cells supplied by that artery. Coronary and Coronary Thrombosis2 are terms that can refer to a heart attack. Another term, Acute myocardial infarction2, means death of heart muscle due to an inadequate blood supply. Sudden Death Sudden death occurs due to cardiac arrest. Cardiac arrest may be the first symptom of coronary artery disease and may occur without any symptoms or warning signs. Other causes of sudden deaths include drowning, suffocation, electrocution, drug overdose, trauma (such as automobile accidents), and stroke. Drowning, suffocation, and drug overdose usually cause respiratory arrest which in turn cause cardiac arrest. Trauma may cause sudden death by severe injury to the heart or brain, or by severe blood loss. Stroke causes damage to the brain which can cause respiratory arrest and/or cardiac arrest. Angina People with coronary artery disease, whether or not they have had a heart attack, may experience intermittent chest pain, pressure, or discomforts. This situation is known as angina pectoris. It occurs when the narrowing of the coronary arteries temporarily prevents an adequate supply of blood and oxygen to meet the demands of working heart muscles.ANGINA PECTORIS Angina Pectoris (from angina meaning strangling, and pectoris meaning breast) is commonly known simply as angina and means pain in the chest. The term "angina" was first used during a lecture in 1768 by Dr. William Heberden. The word was not intended to indicate "pain," but rather "strangling," with a secondary sensation of fear. Victims suffering from angina may experience pressure, discomfort, or a squeezing sensation in the centre of the chest behind the breastbone. The pain may radiate to the arms, the neck, even the upper back, and the pain may come and go. It occurs when the heart is not receiving enough oxygen to meet an increased demand. Angina, as mentioned before, is only temporarily, and it does not cause any permanent damage to the heart muscle. The underlying coronary heart disease, however, continues to progress unless actions are taken to prevent it from becoming worse. Signs and Symptoms Angina does not necessarily involve pain. The feeling varies from individuals. In fact, some people described it as "chest pressure," "chest distress," "heaviness," "burning feeling," "constriction," "tightness," and many more. A person with angina may feel discomforts that fit one or several of the following descriptions: - Mild, vague discomfort in the centre of the chest, which may radiate to the left shoulder or arm - Dull ache, pins and needles, heaviness or pains in the arms, usually more severe in the left arm - Pain that feels like severe indigestion - Heaviness, tightness, fullness, dull ache, intense pressure, a burning, vice-like, constriction, squeezing sensation in the chest, throat or upper abdomen - Extreme tiredness, exhaustion of a feeling of collapse - Shortness of breath, choking sensation - A sense of foreboding or impending death accompanying chest discomfort - Pains in the jaw, gums, teeth, throat or ear lobe - Pains in the back or between the shoulder blades Angina can be so severe that a person may feel frightened, or so mild that it might be ignored. Angina attacks are usually short, from one or two minutes to a maximum of about four to five. It usually goes away with rest, within a couple of minutes, or ten minutes at the most. Different Forms of Angina There are several known forms of angina. Brief pain that comes on exertion and leave fairly quickly on rest is known as stable angina. When angina pain occurs during rest, it is called unstable angina. The symptoms are usually severe and the coronary arteries are badly narrowed. If a person suffers from unstable angina, there is a higher risk for that person to develop heart attacks. The pain may come up to 20 times a day, and it can wake a person up, especially after a disturbing dream. Another type of angina is called atypical or variant angina. In this type of angina, pain occurs only when a person is resting or asleep rather than from exertion. It is thought to be the result of coronary artery spasm, a sort of cramp that narrows the arteries. Causes of Angina The main cause of angina is the narrowing of the coronary arteries. In a normal person, the inner walls of the coronary arteries are smooth and elastic, allowing them to constrict and expand. This flexibility permits varying amounts of oxygenated blood, appropriate to the demand at the time, to flow through the coronary arteries. As a person grows older, fatty deposits will accumulate on the artery walls, especially if the linings of the arteries are damaged due to cigarette smoking or high blood pressure. As more and more fatty materials build up, they form plaques which causes the arteries to narrow and thus restricting the flow of blood. This process is known as atherosclerosis. However, angina usually does not occur until about two-thirds of the artery's diameter is blocked. Besides atherosclerosis, there are other heart conditions resulting in the starvation of oxygen of the heart, which also causes angina. The nerve factor - The arteries are supplied with nerves, which allow them to be controlled directly by the brain, especially the hypothalamus - an area at the centre of the brain which regulates the emotions. The brain controls the expanding and narrowing of the arteries when necessary. The pressures of modern life: aggression, hostility, never-ending deadlines, remorseless, competition, unrest, insecurity and so on, can trigger this control mechanism. When you become emotional, the chemicals that are released, such as adrenaline, noradrenaline, and serotonin, can cause a further constriction of the coronary arteries. The pituitary gland, a small gland at the base of the brain, under the control of the hypothalamus, can signal the adrenal glands to increase the production of stress hormones such as cortisol and adrenaline even further. Coronary spasm - Sudden constrictions of the muscle layer in an artery can cause platelets to stick together, temporarily restricting the flow of flow. This is known as coronary spasm. Platelets are minute particles in the blood, which play an essential role both in the clotting process and in repairing any damaged arterial walls. They tend to clump together more easily when the blood is full of chemicals released during arousal, such as cortisol and others. Coronary spasm causes the platelets to stick together and to the wall of the artery, while substances released by the platelets as they stick together further constrict the blood vessels. If the artery is already narrowed, this can have a devastating effect as it drastically reduces the blood flow. (Fig. 3 - Spasm in a coronary artery) When people are very tense, they usually overbreathe or hold their breath altogether. Shallow, irregular but rapid breathing washes out carbon dioxide from the system and the blood will become over-oxygenated. One might think that the more oxygen in the blood the better, but overloaded blood actually does not give up oxygen as easily, therefore the amount of oxygen available to the heart is reduced. Carbon dioxide is present in the blood in the form of carbonic acid, when there is a loss in carbonic acid, the blood becomes more basic, or alkaline, which leads to spasm of blood vessels, almost certainly in the brain but also in the heart.ATHEROSCLEROSIS The coronary arteries may be clogged with atherosclerotic plaques, thus narrowing the diameter. Plaques are usually collections of connection tissue, fats, and smooth muscle cells. The plaque project into the lumen, the passageway of the artery, and interfere with the flow of blood. In a normal artery, the smooth muscle cells are in the middle layer of the arterial wall; in atherosclerosis they migrate into the inner layer. The reason behind their migration could hold the answers to explain the existence of atherosclerosis. Two theories have been developed for the cause of atherosclerosis. The first theory was suggested by German pathologist Rudolf Virchow over 100 years ago. He proposed that the passage of fatty material into the arterial wall is the initial cause of atherosclerosis. The fatty material, especially cholesterol, acts as an irritant, and the arterial wall respond with an outpouring of cells, creating atherosclerotic plaque. The second theory was developed by Austrian pathologist Karl von Rokitansky in 1852. He suggested that atherosclerotic plaques are aftereffects of blood-clot organization (thrombosis). The clot adheres to the intima and is gradually converted to a mass of tissue, which evolves into a plaque. There are evidences to support the latter theory. It has been found that platelets and fibrin (a protein, the final product in thrombosis) are often found in atherosclerotic plaques, also found are cholesterol crystals and cells which are rich in lipid. The evidence suggests that thrombosis may play a role in atherosclerosis, and in the development of the more complicated atherosclerotic plaque. Though thrombosis may be important in initiating the plaque, an elevated blood lipid level may accelerate arterial narrowing. Plaque Inside the plaque is a yellow, porridge-like substance, consisting of blood lipids, cholesterol and triglycerides. These lipids are found in the bloodstream, they combine with specific proteins to form lipoproteins. All lipoprotein particles contain cholesterol, triglycerides, phospholipids, and proteins, but the proportion varies in different particles.Lipoproteins Lipoproteins all vary in size. The largest lipoproteins are called Chylomicra, and consist mostly of triglycerides. The next in size are the pre-beta-lipoproteins, then the beta lipoproteins. As their size decreases, so do their concentration of triglycerides, but the smaller they are, the more cholesterol they contain. Pre- beta-lipoproteins are also known as low density lipoproteins (LDL), and beta lipoproteins are also called very low density lipoproteins (VLDL). They are most significant in the development of atheroma. The smallest lipoprotein particles, the alpha lipoproteins, contain a low concentration of cholesterol and triglycerides, but a high level of proteins, and are also known as high density lipoproteins (HDL). They are thought to be protective against the development of atherosclerotic plaque. In fact, they are transported to the liver rather than to the blood vessels. Lipoproteins and Atheroma The theory is that lipoproteins pass between the lining cells of the arteries and some of them accumulate underneath. All except the chylomicra, which are too big, have a chance to accumulate. The protein in the lipoproteins are broken down by enzymes, leaving behind the cholesterol and triglycerides. These fats are trapped and set up a small inflammatory reaction. The alpha particles do not react with the enzymes are returned to the circulation. RISK FACTORS There are several risk factors that contribute to the development of atherosclerosis and angina: Family history, Diabetes, Hypertension, Cholesterol, and Smoking. Family History We all carry approximately 50 genes that affect the function and structure of the heart and blood vessels. Genetics can determine one's risk of having heart disease. There are many cases today where heart disease runs in a family, for many generations. Diabetes Diabetics are at least twice as likely to develop angina than nondiabetics, and the risk is higher in women than in men. Diabetes causes metabolic injury to the lining of arteries, as a result, the tiny blood vessels that nourish the walls of medium-size arteries throughout the body, including the coronary arteries, become defective. These microscopic vessels become blocked, impeding the delivery of blood to the lining of the larger arteries, causing them to deteriorate, and artherosclerosis results. Hypertension High blood pressure directly injures the artery lining by several mechanisms. The increased pressure compresses the tiny vessels that feed the artery wall, causing structural changes in these tiny arteries. Microscopic fracture lines then develop in the arterial wall. The cells lining the arteries are compressed and injured, and can no longer act as an adequate barrier to cholesterol and other substances collecting in the inner walls of the blood vessels. Cholesterol Cholesterol has become one of the most important issues in the last decade. Reducing cholesterol intake can directly decrease one's risk of developing heart disease, and people today are more conscious of what they eat, and how much cholesterol their foods contain. Cholesterol causes atherosclerosis by progressively narrowing the arteries and reduces blood flow. The building up of fatty deposits actually begins at an early age, and the process progresses slowly. By the time the person reaches middle-age, a high cholesterol level can be expected.Smoking It has been proven that about the only thing smoking do is shorten a person's life. Despite all the warnings by the surgeon general, people still manage to find an excuse to quit smoking. Cigarette smoke contains carbon monoxide, radioactive polonium, nicotine, arsenious oxide, benzopyrene, and levels of radon and molybdenum that are TWENTY times the allowable limit for ambient factory air. The two agents that have the most significant effect on the cardiovascular system are carbon monoxide and nicotine. Nicotine has no direct effect on the heart or the blood vessels, but it stimulates the nerves on these structures to cause the secretion of adrenaline. The increase of adrenaline and noradrenaline increases blood pressure and heart rate by about 10% for an hour per cigarette. In simpler words, nicotine causes the heart to beat more vigorously. Carbon monoxide, on the other hand, poisons the normal transport systems of cell membranes lining the coronary arteries. This protective lining breaks down, exposing the undersurface to the ravages of the passing blood, with all its clotting factors as well as cholesterol. Multiple Risk Factors The five major risk factors described above do more than just add to one another. There is a virtual multiplication effect in victims with more than one risk factor. (Chart: Risk Factors)DIAGNOSIS It is very important for patients to tell their doctors of the symptoms as honestly and accurately as possible. The doctor will need to know about other symptoms that may distinguish angina from other conditions, such as esophagitis, pleurisy, costochondritis, pericarditis, a broken rib, a pinched nerve, a ruptured aorta, a lung tumour, gallstones, ulcers, pancreatitis, a collapsed lung or just be nervous. Each of the above mentioned is capable of causing chest pain. A patient may take a physical examination, which includes taking the pulse and blood pressure, listening to the heart and lung with a stethoscope, and checking weight. Usually an experienced cardiologist can distinguish it as a cardiac or noncardiac situation within minutes. There are also routine tests, such as urine and blood tests, which can be used to determine body fat level. Blood test can also tests for: Anemia - where the level of haemogoblin is too low, and can restrict the supply of blood to the heart. Kidney function - levels of various salts, and waste products, mainly urea and creatinine in the blood. Normally these levels should be quite low. There are other factors which can be tested such as salt level, blood fat and sugar levels. A chest x-ray provides the doctor with information about the size of the heart. Like any other muscles in the body, if the heart works too hard for a period of time, it develops, or enlarges. An electrocardiogram (ECG) is the tracing of the electrical activity of the heart. As the heart beats and relaxes, the signals of the heart's electrical activities are picked up and the pattern is recorded. The pattern consists of a series of alternating plateaus and sharp peaks. ECG can indicate if high blood pressure has produced any strain on the heart. It can tell if the heart is beating regularly or irregularly, fast or slow. It can also pick up unnoticed heart attacks. A variation of the ECG is the veterocardiogram (VCG). It performs exactly like the ECG except the electrical activity is shown in the form of loops, or vectors, which can be watched on a screen, printed on paper, or photographed. What makes VCG superior to ECG is that VCG provides a three-dimensional view of a single heart beat.DRUG TREATMENT Angina patients are usually prescribed at least one drug. Some of the drugs prescribed improve blood flow, while others reduce the strain on the heart. Commonly prescribed drugs are nitrates, beta- blockers, and Calcium antagonists. It should be noted that drugs for angina only relief the pain, it does nothing to correct the underlying disorder. Nitrates Nitroglycerine, which is the basis of dynamite, relaxes the smooth fibres of the blood vessels, allowing the arteries to dilate. They have a tendency to produce flushing and headaches because the arteries in the head and other parts of the body will also dilate. Glyceryl trinitrate is a short-acting drug in the form of small tablets. It is taken under the tongue for maximum and rapid absorption since that area is lined with capillaries. It usually relieves the pain within a minute or two. One of the drawbacks of trinitrates is that they can be exposed too long as they deteriorate in sunlight. Trinitrates also come in the form of ointment or "transdermal" sticky patch which can be applied to the skin. Dinitrates and mononitrates are used for the prevention of angina attacks rather than as pain relievers. They are slower acting than trinitrates, but they have a more prolonged effect. They have to be taken regularly, usually three to four times a day. Dinitrates are more common than trinitrates or tetranitrates. Beta-blockers Beta-blockers are used to prevent angina attacks. They reduce the work of the heart by regulating the heart beat, as well as blood pressure; the amount of oxygen required is thereby reduced. These drugs can block the effects of the stress hormones adrenaline and noradrenaline at sites called beta receptors in the heart and blood vessels. These hormones increase both blood pressure and heart rate. Other sites affected by these hormones are known as alpha receptors. There are side effects, however, for using beta-blockers. Further reduction in the pumping action may drive to a heart failure if the heart is strained by heart disease. Hands and feet get cold due to the constriction of peripheral vessels. Beta- blockers can sometimes pass into the brain fluids, and causes vivid dreams, sleep disturbance, and depression. There is also a possibility of developing skin rashes and dry eyes. Some beta- blockers raise the level of blood cholesterol and triglycerides. Calcium antagonists These drugs help prevent angina by moping up calcium in the artery walls. The arteries then become relaxed and dilated, so reducing the resistance to blood flow, and the heart receives more blood and oxygen. They also help the heart muscle to use the oxygen and nutrients in the blood more efficiently. In larger dose they also help lower the blood pressure. The drawback for calcium antagonists is that they tend to cause dizziness and fluid retention, resulting in swollen ankles. Other Medications There are new drugs being developed constantly. Pexid, for example, is useful if other drugs fail in severe angina attacks. However, it produces more side effects than others, such as pins and needles and numbness in limbs, muscle weakness, and liver damage. It may also precipitate diabetes, and damages to the retina.SURGERY When medications or any other means of treatment are unable to control the pain of angina attacks, surgery is considered. There are two types of surgical operation available: Coronary Bypass and Angioplasty. The bypass surgery is the more common, while angioplasty is relatively new and is also a minor operation. Surgery is only a "last resort" to provide relief and should not be viewed as a permanent cure for the underlying disease, which can only be controlled by changing one's lifestyle. Coronary Bypass Surgery The bypass surgery involves extracting a vein from another part of the body, usually the leg, and uses it to construct a detour around the diseased coronary artery. This procedure restores the blood flow to the heart muscle. Although this may sound risky, the death rate is actually below 3 per cent. This risk is higher, however, if the disease is widespread and if the heart muscle is already weakened. If the grafted artery becomes blocked, a heart attack may occur after the operation. The number of bypasses depends on the number of coronary arteries affected. Coronary artery disease may affect one, two, or all three arteries. If more than one artery is affected, then several grafts will have to be carried out during the operation. About 20 per cent of the patients considered for surgery have only one diseased vessel. In 50 per cent of the patients, there are two affected arteries, and in 30 per cent the disease strikes all three arteries. These patients are known to be suffering from triple vessel disease and require a triple-bypass. Triple vessel disease and disease of the left main coronary artery before it divides into two branches are the most serious conditions. The operation itself incorporates making an incision down the length of the breastbone in order to expose the heart. The patient is connected to a heart-lung machine, which takes over the function of the heart and lungs during the operation and also keeps the patient alive. At the same time, a small incision is made on the leg to remove a section of the vein. Once the section of vein has been removed, it is attached to the heart. One end of the vein is sewn to the aorta, while the other end is sewn into the affected coronary artery just beyond the diseased segment. The grafted vein now becomes the new artery through which the blood can flow freely beyond the obstruction. The original artery is thus bypassed. The whole operation requires about four to five hours, and may be longer if there is more than one bypass involved. After the operation, the patient is sent to the Intensive Care Unit (ICU) for recovery. The angina pain is usually relieved or controlled, partially or completely, by the operation. However, the operation does not cure the underlying disease, so the effects may begin to diminish after a while, which may be anywhere from a few months to several years. The only way patients can avoid this from happening is to change their lifestyles. Angioplasty This operation is a relatively new procedure, and it is known in full as transluminal balloon coronary angioplasty. It entails "squashing" the atherosclerotic plaque with balloons. A very thin balloon catheter is inserted into the artery in the arm or the leg of a patient under general anaesthetic. The balloon catheter is guided under x-ray just beyond the narrowed coronary artery. Once there, the balloon is inflated with fluid and the fatty deposits are squashed against the artery walls. The balloon is then deflated and drawn out of the body. This technique is a much simpler and more economical alternative to the bypass surgery. The procedure itself requires less time and the patient only remains in the hospital for a few days afterward. Exactly how long the operation takes depends on where and in how many places the artery is narrowed. It is most suitable when the disease is limited to the left anterior descending artery, but sometimes the plaques are simply too hard, making them impossible to be squashed, in which case a bypass might be necessary.SELF-HELP The only way patients can prevent the condition of their heart from deteriorating any further is to change their lifestyles. Although drugs and surgery exist, if the heart is exposed to pressure continuously and it strains any further, there will come one day when nothing works, and all that remain is a one-way ticket to heaven. The following are some advices on how people can change the way they live, and enjoy a lifetime with a healthy heart once more. Work A person should limit the amount of exertions to the point where angina might occur. This varies from person to person, some people can do just as much work as they did before developing angina, but only at a slower pace. Try to delegate more, reassess your priorities, and learn to pace yourself. If the rate of work is uncontrollable, think about changing the job. Exercise Everyone should exercise r f:\12000 essays\health & humanities (196)\Angina Pectororis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Angina Pectoris Angina pectoris is a medical condition that literally means a choked chest. The victim feels acute pain in his chest for a few seconds, and then it goes away. This occurs when myocardium cells, the muscle portion of your heart, are temporarily denied oxygen. At this stage they do not die, but maybe weakened. If left untreated and the disease continues, a serious condition known as myocardial infraction or commonly called a heart attack may occur. This can severely damage the heart's functionality. Which in turn effects our well being. We should be educated about the risks that go along with our cardiovascular system. The most common cause of the condition angina pectoris is over consumption of cholesterol. This chemical is only needed in minute amounts, but is often eaten in every meal. In the body, cholesterol is responsible for the stability of plasma membranes of cells, and hormones are produced from it. If consumed at higher rate then needed it is stored in the tunica interna, the innermost layer, of blood vessels. As it is stored it starts to build up eventually clogging the vessel. As a result of this all cells feed by the vessel die because of a lack of oxygen. If this condition is found early, it can be corrected with surgical procedures or, in some minor cases, corrective procedures. Surgical procedures include bypass, laser and balloon surgery. In bypass surgery a vein is removed from the lower leg and a clogged vessel is worked around. Often in type of surgery the whole mid section of the body is cut and the ribs are pulled back, very painful with a very slow recovery. Some hospitals have now implemented a new technique where only a small hole is made and everything is done via a view screen. In balloon surgery a balloon is inserted into the vessel with the clog and is inflated. When this occurs the vessel is damaged, this causes the cells to repair the damage and clear the clog. This is not as successful as other surgery techniques and is often done several times before a positive result is seen. Laser surgery is the most recent development. Here they use a laser to actually scrape the build up from the vessel. This surgery is one of the most expensive surgeries available today. Corrective procedures include changes in lifestyle. These can include food intake, exercise, and stress-related issues. Food intake is largely the answer to correcting this situation. As shown above excessive intake of cholesterol can increase the risk of a heart attack. Coupled with excessive salt intake can produce another problem known as hypertension or commonly called high blood pressure. This can further increase the risk of a heart attack since the heart has to work harder to achieve a homeostatic state. Therefore the heart is working with less efficiency. For example a runner's heart may beat 64 times a minute. A person with hypertension heart rate may be 98. The runner's heart is working with more efficiency; therefore it does not need to beat as fast as the person with hypertension. The person with hypertension has a high heart rate since it cannot pump as much blood per contraction. Exercise is another corrective procedure prescribed since it increases cardiovascular fitness. As seen above, cardiovascular fitness can reduce the risk of heart attacks. Stress-related issues can increase blood pressure for unknown reasons and therefore can also increase the risk of a heart attack. All these factors can influence the health of our cardiovascular system therefore care must be taken to ensure proper function. This includes handling stress with care, eating, and exercising right. f:\12000 essays\health & humanities (196)\Anorexia and Bulimia Nervosa 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ANOREXIA AND BULIMIA Anorexia Nervosa: a condition characterized by intense fear of gaining weight or becoming obese, as well as a distorted body image, leading to an excessive weight loss from restricting food intake and excessive exercise. Bulimia: an eating disorder in which persistent overconcern with the body weight and shape leads to repeat episodes of binging (consuming large amounts of food in a short time) associated with induced vomiting. To support our definitions we interviewed Dr. David Praul of Charter Hospital by fax. 1. Is there a typical sufferer of Anorexia or Bulimia? While anorexics are often members of the middle class or affluent society, recent findings show sufferers come from all backgrounds and many different styles and sizes of families. Also there is a tendency for anorexics to set unreasonably high goals and to aim for perfection in all that they do. Generally speaking, bulimia is likely to begin after the late teens, while anorexia more often starts during adolescence. The incidence of anorexia or bulimia in males is about 5% of all cases, with the onset of the disorders generally mid-teens to early twenties. 2. What are the causes of the eating disorders Anorexia Nervosa and Bulimia? There are many theories, but no clear picture. It is an over simplification to blame the mass media's presentation to blame the mass media's presentation of the ideal shape: though western society's increased emphasis on the slim, fit body places pressure on many people. We know there are many factors affecting the development of the disorders- biological, psychological and sociological- so the relationship between parent and child need not to be seen as the dominant cause. However the reluctance to mature physically (sexually) and emotionally, and the issues of personal control between parent and child, could contribute to some cases of anorexia. Low self -esteem and poor body image contributes to both disorders; and it seems life crises- such as changing relationships, childbirth or death- may trigger the eating disorders. 3. What are the side-effects of Anorexia and Bulimia? These are described more fully in Anorexia and Bulimia Nervosa Foundation of Victoria's brochures on the disorders. The anorexic experiences physical side-effects similar to malnutritian, with severe sensitivity to the cold, loss of menstral periods and growth of down-like body hair. Bulimic women may also stop mensturating or have irregular periods. Both disorders involve the possible dysfunction of the kidneys, imbalance in the bodily chemicals and damage to colon or urinary tracts. Constant vomiting erodes dental enamel and gives the person a sore throat and gullet. Each disorder places tremendous emotional strain on sufferers, the malnourishment of anorexics actually results in an inability to think clearly or concentrate. Despite many sufferer's reluctance to admit anything is wrong, the quality of life for an anorexic or bulimic person leaves a lot to be desired. Friends and families are alienated by the unpredictable and anti- social behavior of the sufferer. The anorexic and bulimic person is unable to take part in food related activities, and may undergo a complete personality change. Left untreated, both disorders can lead to even death, so I would reccommend expert advice as soon as possible. 4. How are the family and friends of the victim affected by the diseases? Parents often comment on the seceptions practiced by their sick child. While anorexics will usually deny having a problem, bulimics wilo go to great lengths to conceal the problem. It is a shock for a parent to find evidence of vomitting, of empty boxes of laxitives in a daughter's room. Husbands are devistated to learn the reason their wife delays coming to bed each evening is that she is purging herself in the bathroom. The siblings of a sufferer often become co-consdiritors with their brother or sister to keep the truth form their parents. The strain of living with the eating disordered person can create divisions in the family. Each person is involved by the sufferer's behavior in different ways. However, all of the family members feel about the same emotions: confusion, helplessness, anxiousness, and anger. Everybody wonders how to approach the loved one and how to deal with the problem. 5. What can families and friends do to help the sufferers? The fisrt step is to get the problem out in the open, but being really senstive about it and taking great care. The person who has the disorders feels shame and guilt and may feel threatened that the secret is out. They might feel angry, and the feelings need to be worked out in a constructive way. Reassurance that the friends and family do not blame the sufferer will help a lot. Sufferers need to seek professional help and family members need to insist if the sufferer is in danger or in complete denial. An instance of the disorder of Anorexia Nervosa is about a 16 year old girl named Lonnie. Lonnie is five foot seven inches and weighs 82 pounds. She is terrified by eating and gaining weight. Steven Levenkron is the psychotheripist who is treating her. When Steven first meets Lonnie, he describes her as an emaciated young girl without self worth. Lonnie got anorexia when she thought that everyone was staring at her because she was so fat Arbuckle is a 17 year old boy. He subconciously got anorexia. Arbuckle was a runner. He was always told that the lighter you are, the faster you run. So, his mind controled his appetite untio food was no longer appealing to him. On top of all this, Arbuckle was running even more. Some syptoms of anorexia include drastic sudden weight loss and irritability. Bulimia symptoms include evidencer of vomiting and use of laxitives. Both disorders include alienation from friends and family. Both eating disorders are caused by lack of self esteem, many changes in life, or over simplification of life (eg. If I eat, I get fat). Thankfully, anorexia and bulimia are usually treatable through phychotherapy and intense affection, patience, and love. To prevent these eating disordrs, always be on the look out for abnormal social behavior. This is the tell tale sign of mental ilnesses accosiated with your mind. f:\12000 essays\health & humanities (196)\Anorexia and Bulimia Nervosa.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ " When she was fourteen, a modeling agency said that her face was two fat. It was a death sentence." (Toronto Sun, 1994) Sheena Carpenter died in November 1993. She was found on the kitchen floor of her apartment by her mother. She was twenty-two years old. . . and weighed only fifty pounds. Sheena was just one of the alarming numbers of young women who become obsessed with the shape and size of their bodies, and suffer harmful, or in this case, fatal effects from eating disorders. At any given time, almost one out of every two women is on some sort of a diet, and this statistic is apparently reflected the revenues of the diet industry, currently a $33 billion a year industry. It should be noted that this estimate does not include profits generated by exercise or workout programs, gyms, health clubs, or cosmetic surgery. A recent national survey in the US reveled that the majority of women, when asked what would make them happiest, choose thinness over all other choices, even such thing as job promotion, romance, prestige and power. In fact, more women feared becoming fat, then feared dying. These statistics revel an alarming social problem that is reaching epic proportions. Although the topic of eating disorders has gained a larger audience within the last decade, the number of cases of eating disorders continues to rise at a resounding rate. Today many scientists are looking into possible causes for the onset of an eating disorder. The most prevalent and influencing factor is the media and society's view. They act as a controlling presence for susceptible individuals. " The socioculture pressure on today's adolescent and young women to be thin and attractive also play an important role in the development of eating disorders. Thinness in today's society is associated with self-control, attractiveness, intelligence, happiness , wealth and success. The media, fashion, and the diet industry exploit this myth by bombarding us with products and services designed to push us towards losing weight. As a result, it is not surprising to find that adolescents who are undergoing uncontrollable body changes and the onset of new emotional and sexual drives seek dieting in order to enhance their sense of self-control and acceptance by others." Recently it has been discovered that a possible cause for eating disorders is due to an defective hormone. That hormone serotonin, said to activate in response to food, is still a mystery and even though it has some value as a blood clotting factor, but its functions have yet to be totally understood. At the current speed of progress however, it has been said that we should expect definite information as to the cause of an eating disorder in about a decade. Following soon after will be a better form of treatment to help all who have become effected by this dreadful disorder. Both Anorexia and Bulimia have effects and differences on the body that causes the body to take drastic measures to sustain the life of the individual. (for the sake of brevity and to avoid redundancy the abbreviation ED will be used in pace of eating disorder) The lack of any digested food to become a useful ingredient to the body has detrimental effects to the body as a whole. With each disorder, Anorexia and Bulimia Nervosa, you will see how each contributes to this problem. A variety of changes in thought and perception accompany Anorexia Nervosa. Notable behavioral changes, however, center around food. The individual with anorexia often divides her foods into "good" and "bad" categories. Good foods are hypocaloric which includes fruits and vegetables, while bad foods are hypercaloric, such as carbohydrates and sweets. The hypocaloric foods are eaten while hypercaloric foods are avoided. Mealtimes are usually skipped or small amounts of foods may be eaten, leading to low daily calorie intake levels. To an anorexic, every act of eating may be governed by rules such as cutting the food into small pieces, taking hours to eat, or hoarding food. This person also becomes obsessed with exercise in yet another attempt to lose weight. Physically, the disorder causes the body to slowly deteriorate. Obvious signs to look for are excessive weight loss in a short period of time and continuing dieting of a bone thin person. The body, in its amazing capabilities, begins to protect itself by shutting down non-life sustaining processes. The heart rate and blood pressure slow, very fine hairs called lanugo grow on the body to prevent loss of body heat, and the skin becomes dry and yellow. The master gland, the thyroid, slows, which in turn slows development. Amenorrhea begins, stopping the menstrual cycle in women. Due to nutrient restriction and electrolyte imbalance, the heart and kidneys become severely damaged and the brain may even shrink causing drastic personality changes. Bulimia Nervosa is characterized by frequent binge eating, which is followed by some form of compensative behavior, whether it be self-induced vomiting, laxatives, or compulsive exercise. Unlike anorexics who are usually in a state of self denial, bulimics are fully aware of their illness and consciously try to hide it from others. This deception allows the bulimic to carry on for many years without anyone ever knowing. However, the hunger sensation is overwhelmingly strong and the individual gives in, devouring large amounts of food each time. Then guilt and compensatory behaviors follow, such as vomiting or laxative use. Because bulimics only lose the food they've just eaten, they do not drastically lose weight, but fluctuate instead. The body still tries to preserve life and discontinues non-life sustaining processes as well. Many experience signs common to an anorexic such as obsessive exercise, which could led to heavy involvement in sports. Loss of menstrual periods, and feeling fat are also common signs of bulimia. Bulimics still eat but purging starves their bodies of much needed nutrients. This action can lead to heart and kidney damage due to lack of potassium. Purging can also cause the stomach wall and esophagus to rupture, as well as tooth decay due to the acidity of the stomach. ED's have their similarities and differences as can be shown, but inside the body the both cause virtually the same chemical responses. Anorexia and Bulimia Nervosa are two disorders unlike any other disorder, sickness, or disease. The eating disorders such as these two strike in a vulnerable division in the body. The body is sustained by the food we eat and the liquids we drink, take those away or out of their homeostatic state and the body suffers greatly. Although the body is amazing in its capabilities to deal with life functions and changes within, without the proper nutrients, the body is unable to do its job. This is why the disorder is so terrible. The body is unable and incapable without this food to repair itself, provide the means for organs to work, or to sustain life processes. With the limitation of food intake, mineral levels fall towards dangerous levels. As a result vitamins don not work and then food can't be digested and a whole cascade of dangerous effects follow. Minerals are used in the body not a source of food but rather as a aid to other body nutrients. They increase the ability of a nutrient to function and strengthen its effectiveness. With the decrease in food and energy from food, a fluid electrolyte disorder called hyponatremia develops where there is not enough sodium in the body. Made worse by laxatives (diuretics) and excessive sweating through the compulsive exercise, low sodium levels trigger the adrenal cortex to release aldosterone, targeting the kidney tubules. When stimulated, the kidneys raise the absorption rate of Na+ in the proximal convoluted tubules and the loops of Henle. It is important to understand that while the sodium content of the body may change, its concentration in the extracellular fluid remains stabile because of adjustments in water volume. Hyponatremia, when not corrected, causes a neurologic dysfunction due to brain swelling, systemic edemia, decreased water loss which leads to decreased blood pressure and volume, as well as cardiac arrhythmia and circulatory shock. Physical signs of this electrolyte disorder are headaches, muscle cramps, thirst, lethargy, and weakness. Relating very closely to sodium's role in the body is that of potassium. "Potassium, the chief intracellular cation, is required for normal neuromuscular functioning, as well as for several essential metabolic activities, including protein synthesis." Although potassium can be toxic at high levels, eating disorders cause the level of potassium to fall dramatically lower than normal causing the same drastic effects. A deficit of potassium can cause hyperpolarization and nonresponsiveness of the neurons controlling our body, a condition called hypokalemia. The heart, being the most sensitive to K+, may develop cardiac arrhythmia and possible arrest also. Muscular weaknesses, alkalosis of the blood, and hypovenilation may accompany low levels of potassium. The effects of hyponatremia and hypokalemia may not be prevalent at the onset of an eating disorder and may not even show up for quite some time due to the low levels of other chemicals that hinder, compensate, or account for the difference. For example, not enough magnesium (hypomagnesemia) can cause tremors and increase neuromuscular excitability. A lack of phosphorus causes a condition known as rickets, when the epiphyseal plates in young growing children continue to widen and become enlarged. Even a lack in trace minerals like Iron and Iodine can cause an inability to maintain body temperature and hypothyroidism, respectively. Vitamins are essential for the life-sustaining process in the body to be carried out. Vitamins in the body act as a coenzyme. They act in junction with other specific enzymes allowing them to function. Without the assistance of vitamins, all of the carbohydrates, fats, and proteins would not be able to be broken down and digested and used for energy. Most vitamins are not made in the body and therefore most come from our diet, and since no one food contains all of the essential vitamins need for the body, a balanced diet is necessary. The deficiency of vitamins in the body is primarily what causes the effects that are visible in an ED patient. Vitamin A deficiencies cause night blindness (controls pigmentation of rods and cones) and the drying of the epidermis of the skin. Shown in the dry eyes and chapped lips, coarse hair, and the drying eye conjunctiva and yellowing skin. Lack of vitamin D causes problems in the skeleton leading to brittleness and easy breakage of bones. Vitamin K that adds to blood coagulation will cause an increase of clotting time and bruising. Those are to name the effects of low fat-soluble vitamin. The water-soluble vitamins effect the body in yet another way. Vitamin C, labels by many as the "health vitamin", is an antioxidant, meaning that it is used to repair the body of damage from free oxygen radicals. Low levels therefore, let damaged tissue to go unrepaired. Other common problems are an inability to form the intercellular "cement", joint pains, bone growth problems, increased susceptibility to infection, and further weight loss. As the vitamin level dwindles, the body becomes less able to properly digest food into energy. Carbohydrate, lipids, and proteins that due come into the body, can't be broken down properly. The body continually needs energy for basel and regular metabolic rates. When the food intake no longer provides that necessity, the body begins to break down its own resources of stored energy. First to be broken down, is carbohydrates. Carbohydrates consist of sugars and is the easiest obtainable and best used energy source. The complex and simple sugars are broken down directly into glucose. Carbohydrates are burned at a fast rate and since the body doesn't store a lot of it the body next turns upon the lipid or fat reserves. A large portion of energy is storied in fat however it takes more energy to turn it to a useful substance. As the body breaks down itself, the loss of insulating fat causes loss of body heat and an increased metabolic rate. As stored fats become depleted and the body has to due work to keep itself together, next the proteins become targeted. Most proteins are located and stored in muscle. The break down of proteins is really the break down of muscle. Protein digestion is the worst form of energy since it takes a lot of energy to get small amounts of energy. As shown, one thing that may seam minor and minuet can turn into a dangerous situation. Experimentation has proven that the best form of treatment includes the use of anti-depressant drugs. In situation where the patient has become critical the individual is often hospitalized and monitored around the clock with close observation on slow recovery of body chemical. The damages to the body can usually be restored in a relatively short time as compared to the emotional damage that goes on for years. Thankfully most of the physical problems with an eating disorder are caused by malnutrition and go back to normal when normal body weight is restored. f:\12000 essays\health & humanities (196)\Artificial heart devices.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Artificial Heart Devices In its never ending pursuit of advancement, science has reached a crucial biotechnological plateau, the creation of artificial organs. Such a concept may seem easy to comprehend until one considers the vast knowledge required to provide a functional substitute for one of nature's creations. One then realizes the true immensity of this breakthrough. Since ancient times, humans have viewed the heart as more than just a physical part of the body. It has been thought the seat of the soul, the source of emotion, and the center of each individual's existence. For many years, doctors and researchers left the heart untouched because they thought it was too delicate, too crucial to withstand the rigors of surgery. However, the innate human desire to achieve brought about the invention of the artificial heart. The potential for such inventions are enormous. According to the American Heart Association, there are between 16,000 and 40,000 possible recipients of artificial heart devices under the age of sixty-five. If perfected, it would enable us to save thousands of human lives. In considering the full impact of artificial heart devices on society, we must not narrow our thinking to include only the beneficial possibilities. There exist moral, ethical, and economic factors that accompany these new innovations to humanity. Who will receive these brilliant inventions? Obviously not all of the patients will get transplants, so selection criteria must be established. The high price of artificial heart devices and their implantation will eliminate some candidates. Unfortunately, this is not fair. The rich, in essence, can buy life, whereas the poor are abandoned to die in a diseased state. A thorough analysis of the implications of the implantation of such devices reveals not only selection and economic consideration, but mortality and ethics as well. Many contest that it is simply wrong to tamper with the ways and creations of nature. By prolonging life through unnatural means were are defeating natures foremost tenet of the "survival of the fittest." We are preserving the weaker gene pools and contributing to the deterioration of the human species. These and other considerations play a vital role in determining the artificial transplants actual benefit to the contemporary world and the world of tomorrow. A full-scale incorporation of the artificial heart devices technology into the medical world could have serious consequences, all of which must be considered before such a rash step is taken. Artificial heart devices are indeed a biotechnical wonder. Although they are not yet perfected for permanent implantation, they are the most reliable substitutes for bad heart parts until other functional, transplantables can be located. The Jarvik-7 was the first artificial device heart which was created by Symbion Incorporated. This system was used to replace the heart of Dr. Barney Clark, the first artificial heart patient. The device lasted for one-hundred and twelve days before Mr. Clark sank into an agony of complications and died. The Jarvik-7 was implanted four more times to replace failing hearts, with similar results, before the federal authorities halted the procedure. Other devices have made progress since the Jarvik-7. One of the more successful inventions is the left ventricle assist device (LAVD). This device incorporates a host of hard won technological advances. Perhaps the most important is its "bio-compatible" materials, which have allowed the LAVD to function without problems for well over a year in a patient's body. The LAVD has been implanted in more than seven hundred people for up to seventeen months, as they have awaited human heart transplants(Stipp 38). It is difficult to fathom the great scientific ingenuity that was required to develop these devices. However, we must not be blinded from seeing the whole picture. In assuming its role as a boost to humanity, these inventions bring many concerns. The issue of selecting patients for implantation is an important one. There are three alternatives for selecting patients who should have priority to receive artificial heart devices. The first decision- based medical criteria, which seems to make the most sense. This method is meant to choose the ideal patient; the patient who can reap the most benefits not only for himself, but for researchers. Therefore, researchers look for a subject who will yield the information sought and thus produce the gains of new knowledge and therapies. In choosing a subject in this manner, researchers are governed by a principle of nonmaleficence, which means they can do no harm solely in order to further the experimental aspect of the operation. This rule prevents the "mad scientist" mentality from taking hold in experimental research. As Claude Bernard, the father of experimental research stated: "The principle of medical mortality consists in never performing on a man an experiment which might be harmful to him in any extent, though the result might be highly advantageous to science and to the health of others"(Holland 14). It would also seem logical that the decision be based on medical need, but practicality rules these out since many candidates have roughly equal needs for artificial heart devices. A second method of selecting patients is ranking them based on their "social worth." This method would reward those who have benefited the community and demonstrated dedicated social productivity. After all, if someone has helped society, he or she is entitled to their fair return. Although this alternative is based on fair morals, it may meet the problem of social value. Two people might be valuable to society completely different ways, and which one is to receive priority. This also contradicts the American principle of the equality of all human beings, regardless of social contributions. The third method, random selection, may be used to select candidates with equivalent needs for artificial heart devices. Random selection may be accomplished either by lottery or by queuing, which is exemplified by the adage "first come first served." This method seems fair until one considers that one has led criminal lives or have done poorly by society may come out on top. This is definitely not justice. So how should we select patients for implantation's of artificial heart devices? Perhaps the selection process cannot be simply narrowed down to a single criterion, but combinations of several could be used to determine who deserves these transplants the most. As depicted above, the selection of patients is a serious issue in the realm of artificial heart devices. Once a candidate has finally been chosen, however, how is he or she to finance such an elaborate surgical operation? The price for an implant of such complexity is extremely high. The estimated price for an LAVD is about fifty- thousand dollars(Stipp 41). This figure does not include hospital bills for the care and the board of the patient. This is an extravagant amount which most people simply cannot pay. Perfection of artificial heart devices will naturally lead to a widespread demand for the inventions, but still many will be unable to afford it. A total incorporation of heart transplants into the field of medicine would force insurance companies to expand their coverage. The population would benefit from this expansion, as would the insurance companies, since they would surely sell more health insurance plans because of the increased demand. Some believe that the implantation of artificial heart devices will strengthen the case for the national health insurance. Another question to be considered is whether or not it is worth the high cost to have the operation. The common response is to say that a price cannot be put on life, but can we honestly say it is worth thousands of dollars to prolong someone's life for an indefinite length of time? The price may be indeed be too high to postpone what might be a destined fatality. One could spend fifty thousand dollars to have an implant placed in his eighty year-old father's chest, only to witness the death a month later. After all, it is natural for people to die. We all have a destiny which looms over us, over which we have no control. The patient himself must ask if it is worth the money to prolong his life, but to have his quality of health diminish greatly. With today's technology, an artificial heart recipient's mental state may become very distraught. Thoughts of death hover over his head, as he can never predict when the device may fail. The use of artificial heart devices as a viable technique will undoubtedly raise many legal and ethical questions. Before completing the discussion of artificial heart technology, these questions must be addressed. An important requirement for the surgical operation is that the surgeon must receive the informed consent of the patient. The patient must be aware of the nature of the operation and its dangers, and still be willing to go through with the procedure. However, a real life scenario may occur which does not allow for the patients consent. For example, suppose a patient is on the operating table undergoing bypass surgery and sudden complications occur involving heart failure. The doctor uses his best judgment to find the only way to save the patient's life; he inserts an artificial heart device. The physician may be endangering the patient's life by removing the natural heart and inserting an artificial device. However, the transplant without informed consent should be considered as an emergency medical operation. Possibly the patient's family should be the consenting party. This sounds like a suitable solution, but factors such as greed may interfere with the family's decision. If the patient has a large life insurance plan, his beneficiaries may consent to the artificial implant since it would greatly improve the risk to the patient's life. The perfection of artificial devices for the heart will definitely have a great impact on society. This can be classified in two major ways: financial problems and population problems. Of course, increased use of artificial heart devices in medicine is going to increase the financial burden on society. The potential gains will be substantial when the lives of many productive individuals can be saved. The extent of the financial burden depends largely upon the number of patients who benefit from the artificial valve, the availability of the device, and improvements in its efficiency and dependability. In the long run, worldwide utility of the artificial valve technology would increase the world population. Overpopulation is already the root of many of the world's crises. The many debates concerning artificial heart implantation as a medical technique each have their own significance, and each deserves thorough consideration. Before we rush headlong into complete employment of the devices in medicine, we must evaluate the moral, social, ethical, arguments. Hopefully we can reach a decision that blends all of the aforementioned considerations into a harmonious existence, working to the maximum benefit of society. f:\12000 essays\health & humanities (196)\Artificial Life or Death.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Artificial Life or Death Euthanasia has been a hotly debated about topic for the past couple of decades, but has recently been thrust into the limelight by many controversial court and hospital decisions. Euthanasia is defined as the "mercy killing" of a person who is brain dead, terminally ill or otherwise at death's door. This usually, but not necessarily, affects people who are are separated from death only by machines. Whether you personally believe "mercy killing" is a viable solution in a hopeless situation or not the proponents for both sides provide arguments that can be quite convincing. Supporters of euthanasia say that it is such an improbability for a miraculous recovery and a return to a normal life that it is not worth putting the patient through all the suffering and agony that prolonging their life would cause or the fortune of hospital bills that you would pay. The opposition feels that it is not right for people to abandon other members of the human race because there is always a chance, even though it is a small one, that they will regain all functons and return to a normal life. There are many cases in which euthanasia is acceptable. Brain death is one situation which merits euthanasia. It is also one of the more common cases where euthanasia is requested. Brain death is when all brain activities cease. The lines are fairly well drawn in the law about patients who are suffering but are still compotent, but when the law is asked to determine the fate of a lingering, comatose, incompotent patient the lines begin to blur. In many cases the courts turned to the patient's family, but what if there are not any or they disagree? In such cases who decides? In a controversial decision a Massachusetts court allowed that it would invoke its own "substitute judgement" on behalf of a mentally ill woman. In a second case mentioned in the January 7 issue of Newsweek, a Minnesota Surpreme court turned to three hospital ethics committees to review a dying loner's case, followed their collected wisdom and ordered him off the respirator so that he could have a dignified death. "It is the first time ethics committees played a significant role in the court" says Dr. Ronald E. Cranford. Still the easiest way to know and respect the patient's wishes is through a simple piece of paper called a living will. (18) It was stated, in the Bible, by the same preacher in Ecclesiastes who said there is a time to be born and a time to die also said there is "A time to search and a time to give up" (Ecclesiastes 3:6) We need the honesty to admit death and the courage to discontinue life extending measures, because of the extreme amount of funds that go into supporting a brain dead, comatose, or terminally ill patient for any amount of time. Although brain dead and comatose patients do not feel pain terminally ill patients do, so is it not better to stop the pain that prolonging life would cause? It also seems to me that the brain dead patient lying in the hospital bed coupled to machines is unlike the person that you knew and loved. In U.S.A. Today a situation was written about that promotes this way of thinking, it says "Typical is the inert body of an eighty two year old woman, victim of a massive coronary, lying day after day hooked up to tubes and wires with no prospect of returning to consciousness, much less to last week's vitality which her daughter remembers as she says, 'That is not my mother lying there'." (34) Many think that "We should be very careful in terms of our technological miricals that we do not impose life on people who, in fact, are suffering beyond our ability to help." In Christianity Today January, 1990 there is a statement that I think is the epitome of all that advocates of euthanasia say and believe, "In todays society, where technological advances have given us the power to prolong the quantity of life long beyond what many believe is life with any dignity or degree of quality, pulling the plug or removing the tube should not be considered a sin of commission, murder, or suicide ; but a humble acknowledgement of our finitude." (6) Should we ever give up on our friends and family, isn't there always a chance of normal life? "After an accident that seems to wipe out all or most of its victim's vital functions, it is often impossible to read the future. The person might someday surprise us, wake up, and walk." (Christianity Today Jan 1990 p.6) Is it not better to attempt to keep them alive and they still die a natural death than to not try and give up all hope on our loved ones? The Cruzan case is one example where a comatose girl named Nancy needed a loving, praying, and caring family. She did not need a family that would just give up on her and let her slip into the eternal sleep of death. Is it fair that people that barely new the patient are the ones to choose the patient's fate. Like the time a Minnesota Surpreme Court turned to ethic committees, followed what they said and killed a dying man. (Newsweek Jan. 7,1985 p.18) I do not see how people who never even met the patient before he was condemned to die are knowlegeable of the patient's wishes or realy even what the family desires. (18) The Holbrook case is one example where a man was miraculously revived after being in a coma for eight years after he was hit on the head with a piece of firewood. Effie Holbrook said that she never gave up hope on her son. Her prayers were answered February 25, 1991 When Conly Holbrook, called her name. Holbrook then told his mother the names of the two people he said hit him. After the assault, he was in a coma for three months before they had to remove part of his skull to relieve pressure on his brain. He had been in a comatose state ever since. Living Wills are growing in popularity since the numbers of "mercy killings" have grown. A living will is a declaration of the desire for a natural death. It is a means of retaining control over what happens at the end of your life, even when you are no longer able to express your wishes. To many people, the fear of a lingering death is worse than the fear of dying, and a Living Will permits you to make certain choices when there is not doubt that you are compotent. North Carolina and many other states have adopted Living Will laws. North Carolina has recognized them since 1977. G.S. 90-321 provides that if an idividual has declared in the proper manner a desire that his or her life not be prolonged by extraodinary means, and if attending physician determines the individual's condition is terminal and incurable and is confirmed by another physician, then extraodinary means may legally be withheld or discontinued. When you sign a Living Will the decision does not have to be a permanent one. You may revoke a Living Will at any time by destruction of original and all copies or by communication of your intention to evoke the will. The line between whether euthanasia is acceptable or not is quite fine and we all need to be careful when it comes to the point of euthansia. You must have your priorities straight before you make a final decision on your, or someone elses, fate. Would you want to be killed? Would you want your wife killed after a car wreck or would you rather allow her or you to go on living by life support? Euthanasia is so touchy that most people would never, and should never want, to have to make this decision between life and death. f:\12000 essays\health & humanities (196)\asprin.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Aspirin Aspirin may not be healthy for the DIGESTIVE TRACK it can also sometimes cause serious bleeding in the upper GASTROINTESTINAL tract. A study director of medicine said the risk of bleeding is directly related to aspirin. She also stated that 1/4 of an aspirin is good for a day (about the same amount of a baby's aspirin). Another thing she stated was that if you are taking aspirin for arthritis it may cause severe bleeding. Late last moth in a journal called Lancet , Lancet compared the use of aspirin among 550 people admitted to the hospital with serious bleeding from the stomach or DUODENUM with the aspirin-taking practices of 1,202 non hospitalized people from the same communities. An aspirin-induced ULCER or gastric-an inflammation of the stomach lining is the cause of such bleeding that typically results in vomiting blood. In virtually everyone who takes aspirin the aspirin may cause MICRO BLEEDING. The more serious bleeding is rare however it is death threatening, Especially if the person has any other medical problems or has lost a lot of blood quickly. In a survey 19 per 100,000 people had the serious bleeding. It is precisely the power of the aspirin that makes it effective against heart attacks and strokes that are caused by clots. I think that you should not take aspirin for preventing any heart attacks or strokes or etc.... for a reason and that reason is that it may cause another hazard upon you while you are trying to prevent one happening to you. Digestive track - The way food is digested. Gastrointestinal - Of relating to, affecting, or including both stomach and intestine. Duodenum -The first part of the small intestine extending from the pylorus to the jejunum. Ulcer - An open sore on the inner surface of the alimentary canal. Micro bleed -The loss of tiny amounts of blood from the gastrointestinal track that may show up in the stool. FACTS 1. One regular aspirin a day is not very good for you. 2. Aspirins make you bleed in many different parts of the body. 3. Aspirin may cause death in some cases. 4. The more aspirin you take the more of the chance of you bleeding or even sometimes dying. 5. A large amount of people bleeds from Aspirin. f:\12000 essays\health & humanities (196)\Assisted Suicide.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Assisted Suicide "Should Doctors assist their patient's death? The doctors' obligation is to provide every possible support during the process of dying. Do doctors have the right to hasten the process, when requested to do so? There has been a great deal of discussion over this topic for the past few years." For many years now, assisted suicide has been a debated topic of who believes in it and who does not. The Christian faith disagrees in the act of assisted suicide. "This religion teaches redemptive suffering. God sends suffering as a means of washing away people's sins and saving their souls. It is believed that people can be blessed if they endure their misery." Islam has a similar belief of the Christian faith. They believe assisted suicide is an account of murder. In some countries, the patient who committed suicide, and the physician, or doctor that assisted the patient, should both go to hell. "We don't own ourselves, we are entrusted to God and the taking of life is the right of the one who give it." There are also many cultures that believe in this act of dying. Certain cultures believe that they have the right to end a person's life, only if the person is suffering with an illness that will only get worse. "In China and some parts of India, it is an ancient custom to drown newborn girls if they think they will live a useless life." The Dutch believe in the act of assisted suicide as many other religions. They believe that it is easier to end a life so the family and the other people will not have to go through all the suffering and pain. Many Physicians today believe that assisted suicide is the answer to end all the pain and suffering in the world. Dr. Peter Admirral is a physician that is known for ending more than one hundred lives in less than thirty years. "The emotion is what you prescribed or what you have injected will cause the patient to die. Its so opposite to normal feelings of a doctor that you have to go through a period of resisting this. Although you must remember the patient is you friend." Another Physician that is highly noted for assisted suicide is Dr. Jack Kevorkian. He believes that he is a hero to all of his patients. "If it wasn't for me, life would seem like it would never end to all of my patients that are suffering from illness." "I have never actually caused a death, but I help people exercise their last civil right. I think physicians who oppose assisted suicides are similar to Nazi doctors, people who torture and experiment on Holocaust victims. Actually, it is the same as torture, to watch someone suffer when you can do something to end that suffering." "People from the age of 45 to the age 64 make up the largest percentage of assisted suicide cases in the US. The people that make up most of the percentage are people who are chronically ill with cancer or other forms of deadly disease. People with AIDS are twelve times likely to choose euthanasia or assisted suicide as the rest of the population." "Twenty-one year old Karen Quinland was at a friend's house celebrating a birthday. Before the birthday party, she had gone on a diet and had eaten very little. She had also been suspected of taking tranquilizers or other kinds of drugs. Before the party, Karen suspects of consuming a few alcoholic beverages. Her friends said that she had then started to act kind of strange. They decided to take her to one of the rooms in the house and lay her on the bed. About an hour later, her friends went upstairs and checked on her, they then found out that she was in a coma and they could not wake her. They called a ambulance immediately." After the ambulance made back to the hospital, Karen Quinland went into breathing deficiency. Karen's doctor got the parents consent to put her on a respirator. After a couple of days on the respirator, Karen's mom decided that Karen would probably want to end her life and would not want to suffer any more. According to the law, taking her off of the respirator would be an act of assisted suicide. The person whom does this would face accounts of murder and would likely be put in prison or if lucky, prosecution. After many court cases and arguments, the Supreme court allowed the doctor to take Karen off life support. Most people the would argue that Karen Quinland's privacy and her right to make decisions was infringed. According to the law, her parent had the right to make the decision for her since she was unable. Janet Adkins, a member of the Hemlock Society, believes highly in self deliverance. Self deliverance is being able to choose her own manner of death. She suggested the idea of assisted suicide to Dr. Kevorkian. The Hemlock Society that Adkins was a member of did not support Dr. Jack Kevorkian. Most of the people that Kevorkian deals with are not in the absence of terminal illness. A lot of the suicide victims are in a tragic part of there lifetime such as when one of their family members just passed away or they might have just got a divorce. They think that they cannot live any longer and want Kevorkian to put them to sleep. That is abusing assisted suicide, it should only be used in case of a terrible illness which cannot be reversed. What about babies? If a baby was born with a major birth deficiency and was not likely to live, should the parents have the right to put the baby to sleep? Is that Murder? "Some Physicians argue that attempting to keep an infant alive under such conditions is useless and only brought hardship and pain to the families." "After many hearings with medical groups and advocates for handicapped, Congress passes legislation in 1984 that allowed exemptions for treating severely damaged infants. Doctors are no longer required to treat an infant in a irreversible coma or to provide treatment that would only prolong dying." "Baby Doe is a boy that was born in a hospital in Bloomington, Indiana in 1982. He was born with a deficiency called down syndrome, this syndrome causes a form of mental retardation recognized at the facial characteristics. The baby's esophagus also was malformed, anything given by mouth would end up in the baby's lungs causing suffocation. Two pediatricians at the hospital recommended that the baby should be transported to a hospital in nearby Indianapolis, the surgery would correct the babies esophagus. Two other doctors said that the surgery might not be successful and of course would have no effect on the baby's mental retardation. They also said that the baby should stay in the Bloomington Hospital and be kept comfortable until death occurred. As required by law, parents have to consent to any form of medical treatment for their child. The parents then decided to keep the baby at the Bloomington Hospital. Since other doctors disagreed with this idea, they called an emergency hearing. The Judge then decided that Baby Doe's parents had the right to make an informed decision about the course of treatment for their child as recommended by their doctor. Many disagreements came across the press after the baby had died." Many Right-to-life activists and handicapped people and their advocates proclaimed that the baby should have been saved. Assisted suicide is a blessing to many people in the World. Some say that assisted suicide has thankfully ended the pain and suffering of their loved ones. A lot of people also take advantage of this, mostly as a way to run away from their problems and fears of everyday life. Assisted suicide is only a relief to pain and suffering. The only way you or your family member should consider this is if they are terminally ill or are expecting to have a slow painful death. f:\12000 essays\health & humanities (196)\ASSUMPTIONS AND PRINCIPLES UNDERLYING STANDARDS FOR CARE OF T.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ ASSUMPTIONS AND PRINCIPLES UNDERLYING STANDARDS FOR CARE OF THE TERMINALLY ILL Introduction There is agreement that patients with life-threatening illnesses, including progressive malignancies, need appropriate therapy and treatment throughout the course of illness. At one stage, therapy is directed toward assessment and intervention in order to control and/or to cure such illness and alleviate associated symptoms. For some persons, however, the time comes when cure and remission are beyond current medical expertise. It is then that the intervention must shift to what is now often termed "palliative treatment," which is designed to control pain in the broadest sense and provide personal support for patients and family during the terminal phase of illness. In general, palliative care requires limited use of apparatus and technology, extensive personal care, and an ordering of the physical and social environment to be therapeutic in itself. There are, as it were, two complementary systems of treatment which may often overlap: One system is concerned with eliminating a curable disease and the other with relieving the symptoms resulting from the relentless progress of an incurable illness. There must be openness, interchange, and overlap between the two systems so that the patient receives continuous appropriate care. The patient should not be subjected to aggressive treatment that offers no hope of being effective in curing or controlling the disease and may only cause further distress. Obviously, the clinician must be on the alert for any shifts that may occur in the course of a terminal illness, which make the patient again a candidate for active treatment. Patients suffer not only from inappropriate active care, but also from inept terminal care. This is well documented by studies that only confirm what dying patients and their families know at first hand. These principles have been prepared as an aid to those who have initiated or are planning programs for the terminally ill in delineating standards of care. GENERAL ASSUMPTIONS AND PRINCIPLES AssumptionsPrinciples1. The care of the dying is a process involving needs of the patient, family, and caregivers. The interaction of these three groups of individuals must constantly be assessed with the aim being the best possible care of the patient. This cannot be accomplished, however, if the needs of the family and/or caregiver are negated. 2. The problems of the patient-family facing terminal illness include a wide variety of issues: psychological, legal, social, spiritual, economic, and interpersonal. Care requires collaboration of many disciplines working as an integrated clinical team, meeting for frequent discussions, and with commonness of purpose. 3. Dying tends to produce a feeling of isolation. All that counteracts unwanted isolation should be encouraged; social events and shared work, inclusive of all involved, should be arranged so that meaningful relations can be sustained and developed. 4. It has been the tradition to train caregivers not to become emotionally involved, but in terminal illness the patient and family need to experience the personal concern of those taking care of them. Profound involvement without loss of objectivity should be allowed and fostered, realizing this may present certain risks to the caregiver. 5. Health care services customarily lack coordination. The organization structure must provide links with existing health care professionals in the community. 6. A supportive physical environment contributes to the sense of well being of patients, of family, and of caregivers. The environment should provide adequate space, furnishings that put people at ease, the reassuring presence of personal belongings, and symbols of life cycles. PATIENT-ORIENTED ASSUMPTIONS AND PRINCIPLES AssumptionsPrinciples7. There are patients for whom aggressive curative treatment becomes increasingly inappropriate These patients need highly competent professionals, skilled in terminal care.8. The symptoms of terminal disease can be controlled. The patient should be kept as symptom free as possible. Pain in all its aspects should be controlled. The patient must remain alert and comfortable. 9. Patients' needs may change over time. Staff must recognize that other services may have to be involved, but that continuity of care should be provided. 10. Care is most effective when the patient's lifestyle is maintained and life philosophy respected. The terminally ill patient's own framework of values, preferences, and life outlook must be taken into account in planning and conducting treatment. 11. Patients are often treated as if incapable of understanding or of making decisions. Patients' wishes for information about their condition should be respected. They should be allowed full participation in their care and a continuing sense of self-determination and self-control. 12. Dying patients often suffer through helplessness, weakness, isolation, and loneliness. The patient should have a sense of security and protection. Involvement of family and friends should be encouraged. 13. The varied problems and anxieties associated with terminal illness can occur at any time of day or night. Twenty-four hour care must be available seven days a week for the patient/family where and when it is needed. FAMILY-ORIENTED ASSUMPTIONS AND PRINCIPLES AssumptionsPrinciples14. Care is usually directed towards the patient. In terminal illness the family must be the unit of care. Help should be available to all those involved whether patient, relation, or friend to sustain communication and involvement. 15. The course of the terminal illness involves a series of clinical and personal decisions. Interchange between patient, family, and clinical team is essential to enable an informed decision to be made. 16. Many people do not know what the dying process involves. The family should be given time and opportunity to discuss all aspects of dying, death, and related emotional needs with the staff. 17. The patient and family need the opportunity for privacy and being together. The patient and family should have time alone and privacy both while the patient is living and after death occurs. A special space may need to be provided. 18. Complexity of treatment and time-consuming procedures can cause disruption for the patient/family. Procedures must be so arranged as not to interfere with adequate time for patient, family, and friends to be together. 19. Patients and families facing death frequently experience a search for the meaning of their lives, making the provision of spiritual support essential. The religious, philosophic, and emotional components of care are as essential as the medical, nursing, and social components and must be available as part of the team approach. 20. Survivors are at risk emotionally and physically during bereavement. The provision of appropriate care to survivors is the responsibility of the team that gave care and support to the deceased. STAFF-ORIENTED ASSUMPTIONS AND PRINCIPLES AssumptionsPrinciples21. The growing body of knowledge in symptom control, patient/family-centered care, and other aspects of the care of the terminally ill is now readily available. Institutions and organizations providing terminal care must orient and educate new staff and keep all staff informed about developments as they occur. 22. Good terminal care presupposes emotional investment on the part of the staff. Staff needs time and encouragement to develop and maintain relationships with patients and relatives. 23. Emotional commitment to good terminal care will often produce emotional exhaustion. Effective staff support systems must be readily available. f:\12000 essays\health & humanities (196)\Attention Deficit Disorder.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Attention Deficit Disorder For centuries children have been grounded, beaten, or even killed for ignoring the rules or not listening to what they're told. In the past it was thought these "bad" kids were the products of bad parenting, bad environment, or simply being stubborn, however it is now known that many of these children may have had Attention Deficit Disorder, or A. D. D., and could've been helped. A. D. D. is a syndrome that affects millions of children and adults in the United States and is a very frustrating and confusing syndrome that often goes undiagnosed. While there is no clear-cut definition of A. D. D., it's known that it's a genetic disorder that affects males more often than females, in a 3:1 ratio, and is marked by a classic triad of symptoms, which are impulsivity, distractibility, and hyperactivity (Hallowell 6). There are two general types of A. D. D., the stereotypical, high-energy, hyperactive group, and the less known underactive ones that often daydream and are never mentally present anywhere. Typically, people with A. D. D. are very likable and are usually very emphatic, intuitive, and compassionate, however they have very unstable moods that can range from an extreme high to an extreme low instantly, for no apparent reason. Usually, they procrastinate often and have trouble finishing projects, while conversely, they can hyperfocus at times and accomplish tasks more quickly and efficiently than a normal person could. Often they have short tempers and lack the impulse to stop themselves from blowing up over minor details (Hallowell 10). Although A. D. D. has just recently been discovered and there is still relatively little known about it, it has an interesting history. In 1902, George Frederic Still first thought that the dilemma of problem children was a biological defect inherited from an injury at birth and not the result of bad parenting. In the 1930's and '40's stimulant drugs were first used to successfully treat many behavior problems due partly to Still's hypothesis. In 1960, Stella Chess further boosted research in the field by writing about the "hyperactive child syndrome." She stated that the behavior problems weren't a product of injury at birth, but instead were inherited genetically. Finally, in 1980, the syndrome was named A. D. D., due in large part to Virginia Douglas' work to find accurate ways to diagnose it (Hallowell 12). Formally, A. D. D. comes in two types: A. D. D. with hyperactivity and A. D. D. without hyperactivity (Hallowell 9). However there are several other subtypes that are used to diagnose the syndrome and aren't formally recognized. The six most interesting, though not necessarily most prevalent, are A. D. D. without hyperactivity, A. D. D. with agitation or mania, A. D. D. with substance abuse, A. D. D. in the creative person, "high-stim" A. D. D., and pseudo-A. D. D. The first subtype, A. D. D. without hyperactivity, is the most frequently seen subtype. A common misconception about A. D. D. is that it's only present in hyperactive people, while in this subtype the people are underactive, even languid. These people are the daydreamers that drift off to their own world during class or during conversations. This type is most common in females and the core symptom is distractibility. This, while being the most frequent, is also the hardest to diagnose because it seems that the people simply "need to apply themselves" or "get their act together (Hallowell 153)." The second type, A. D. D. with mania or agitation, can often be mistaken for manic-depression due to the high energy levels involved in both and the rapid changes in mood. However, on can distinguish between the two by their response to medication. People without a favorable response to lithium, the drug prescribed to manic-depressives, quite likely have A. D. D. A difficult twist to diagnosis is that the two may coexist. This occurs when the person cycles between mania and A. D. D. (Hallowell 169). The third subtype is A. D. D. with substance abuse. Substance abuse is one of A. D. D.'s hardest "masks" to see through because the abuse itself can produce A. D. D.-like symptoms. Often when a person with A. D. D. has substance abuse problems they unknowingly are self-medicating themselves with the drugs. They do this when they choose to use the drug continually simply because it clears the static from their mind (Hallowell 174). The three substances used most by A. D. D. sufferers are cocaine, alcohol, and marijuana. With cocaine, the person feels focused and alert as opposed to the average state of being high and out of control, because the cocaine acts as a stimulant, much like Ritalin, to the part of the brain that's dysfunctional in A. D. D. (MacLean 11). The fourth subtype of A. D. D. is A. D. D. in the creative person. At first, one might think A. D. D. would hinder creativity but, in fact, many elements of A. D. D. favor creativity. One of these is the disarrangement of thought the A. D. D. sufferer lives with and, in order to be creative, one must get comfortable with disarrangement. Also, a cardinal symptom of A. D. D. is impulsivity, and what is creativity other than an impulse gone right (Hallowell 177)? A. D. D.'s ability to hyperfocus at times also can contribute to creativity because a person can fiercely attach to an idea and work it to the end. The only real disadvantage to creativity in A. D. D. is harnessing these elements to carry through with the brilliant ideas. "High-stim" A. D. D. is the fifth and most interesting type of A. D. D. "High-stim" A. D. D. occurs when a person seeks out highly stimulating, and often dangerous, situations to avoid boredom. In the person with A. D. D., a high-risk situation provides extra motivation which has been proven to help the person focus. Often a child with this type of A. D. D. will pick fights with others to spice up a situation without necessarily being angry (Hallowell 179). The sixth and final subtype of A. D. D., pseudo-A. D. D., isn't actually A. D. D. at all. Instead, it's just the mistaken impression that A. D. D. is just the way life is for everyone. The reason for this false feeling is that life itself is much like A. D. D. with its fast pace, high stimulation, violence, anxiety, etc. The way one can tell between pseudo-A. D. D. and genuine A. D. D. is the duration and intensity of the symptoms (Hallowell 193). There are five basic steps to treating A. D. D. The fist is diagnosis which, in itself, can provide great relief. The second is education because the more one understands A. D. D., the better one can understand how to solve the problems it creates. The third step is providing structure, which is important in reducing the inner chaos and providing a sense of control. The fourth step is having someone to provide encouragement, instructions, and reminders to the person with A. D. D. The fifth, and final, step is medication, which helps by correcting a chemical imbalance in the brain. Unfortunately, this doesn't work for everyone and it should not be used as the only treatment (Hallowell 14). Some common medications for A. D. D. are Ritalin, Dexedrine, Cylert, Tofranil, Norpramin, and Catapres which all have their own, individual positive and negative aspects (MacLean 11). Also, one must beware of controversial treatments that have overstated or exaggerated claims, that claim to treat many ailments, and/or claim that they have been unfairly attacked by the "Medical Establishment (CH. A. D. D. 1)." With increased knowledge and acceptance of A. D. D., society can help itself in at least two major ways. One, it could lessen the prison population because a large number of inmates have undiagnosed A. D. D. and, given proper treatment can overcome their problems to live a productivelife. Second it could tap into a large, unused base of intelligent people with undiagnosed A. D. D. to help further mankind. Overall, A. D. D. isn't something to be overlooked and pushed aside due to the many benefits understanding it would give. WORKS CITED CH. A. D. D. "Controversial Treatments for Children with Attention Deficit Disorder." Online. Internet. 1995 Hallowell, Edward M. and John J. Ratley. Driven to Distraction. Simon and Schuster. New York: 1994. MacLean, Marvin E. "Medications and A. D. D." The Journal of Bio/Behavioral Dynamics. September, 1995: pg. 11. f:\12000 essays\health & humanities (196)\Attention Deficit Hyperactivity Disorder.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Attention Deficit Hyperactivity Disorder (ADHD) Imagine living in a world where sights, sounds, images and thoughts are constantly changing and shifting. Unable to focus on whatever task is at hand, your mind wanders from one activity or thought to the next. Sometimes you become so lost among all the thoughts and images that you don't even notice when someone is speaking to you. This is what it is like for many people who have Attention Deficit Hyperactivity Disorder, or ADHD. Once called hyperkinesis or minimal brain dysfunction, ADHD is one of the most common mental disorders among children. It affects 3 to 5 percent of all children, and it is likely to occur two to three times more in boys than in girls. People who have ADHD may be unable to sit still, plan ahead, finish tasks, or be completely aware of what is going on in the world around them. However, on some occasions, they may appear "normal", leading others to believe that the person with ADHD can control such behaviors. As a result of this, ADHD can hinder the person's relationships and interactions with others in addition to disrupting their daily life and lowering self-esteem. To determine whether or not a person has ADHD, specialists must consider several questions: Do these behaviors occur more often than in other people of the same age? Are the behaviors an ongoing problem, not just a response to a [temporary] situation? Do the behaviors occur only in one specific place or in several different settings? In answering these questions, the person's behavior patterns are compared to a set of criteria and characteristics of ADHD. The Diagnostic Statistical Manual of Mental Disorders (DSM) presents this set of criteria. According to the DSM, there are three patterns of behavior that indicate ADHD: inattention, hyperactivity, and impulsivity. According to the DSM, signs of inattention include: becoming easily distracted by irrelevant sights and sounds; failing to pay attention to details and making careless mistakes; rarely following instructions carefully and/or completely; and constantly losing or forgetting things like books, pencils, tools, and such. Some signs of hyperactivity and impulsivity, according to the DSM, are: the inability to sit still, often fidgeting with hands and feet; running, climbing, or leaving a seat in situations where sitting or quiet, attentive behavior is required; difficulty waiting in line or for a turn; and blurting out answers before hearing the entire question. However, because almost everyone will behave in these manners at some time, the DSM has very specific guidelines for determining if they indicate ADHD. Such behaviors must appear early in life, before age 7, and continue for at least 6 months. For children, these behaviors must occur more frequently and severely than in others of the same age. Most of all, the behaviors must create a true handicap in at least 2 areas of the person's life (e.g. school, home, work, social settings). One of the difficulties in diagnosing ADHD is that it is usually accompanied by other problems. Many children who have ADHD also have a learning disability. This means that they have trouble with certain language or academic skills, commonly reading and math. A very small number of people with ADHD also have Tourette's syndrome. Those affected by Tourette's syndrome may have tics, facial twitches, and other such movements that they cannot control. Also, they may grimace, shrug, or yell out words abruptly. Almost half of all children with ADHD, mostly boys, have another condition known as oppositional defiant disorder. This sometimes develops into more serious conduct disorders. Children with this disorder, in conjunction with ADHD, may be stubborn, have outbursts, and act belligerent or defiant. They may take unsafe risks and break laws -- ultimately getting them into trouble at school and with the police. Still, not all children with ADHD have an additional disorder. The same is true for people with learning disabilities, Tourette's syndrome, etc. They do not all have ADHD with their initial disorder. However, when ADHD and such disorders do occur together, the problems can seriously complicate a person's life. As we speak, scientists are discovering more and more evidence suggesting that ADHD does not stem from home environment, but from biological causes. And over the past few decades, health professionals have come up with possible theories about what causes ADHD. But, they continue to emphasize that no one knows exactly what causes ADHD. There are just too many possibilities [for now] to be certain about the exact cause. Therefore, it is more important for the person affected [and their family] to search for ways to get the right help. A common method for treating ADHD is the use of medications. Drugs known as stimulants seem to have been the most effective with both children and adults who have ADHD. The three which are most often prescribed are: methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). For many, these drugs dramatically reduce hyperactivity and improve their ability to focus, work, and learn. Research done by the National Institute of Mental Health (NIMH) also suggests that medications such as these may help children with accompanying conduct disorders control their impulsive, destructive behaviors. However, these drugs don't cure ADHD, they only temporarily control the symptoms. Many health professionals recommend that these medications be used in combination with some type of therapy, training, and/or support group. Such options include: psychotherapy, cognitive-behavioral therapy, social skills training, parental skills training (for parents with ADHD children), and support groups. Although most people with ADHD don't "outgrow" it, they do learn how to adapt and live better, more fulfilling lives. With the proper combination of medicine, family, and emotional support, people who have ADHD can develop ways to better control their behavior. Through further studies, scientists are better understanding the nature of biological disorders. New research is allowing us to better understand how our minds and bodies work, along with new medicines and treatments that continue to be developed. Even though there is no immediate cure for ADHD, research continues to provide information, knowledge, and hope. f:\12000 essays\health & humanities (196)\Auguments about Abortion.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Auguments about Abortion Abortion is one of the most controversial issues around, and is an issue that will never be agreed upon. By bringing morals into the question of whether it should be legal to have abortions, this issue has been elevated to a higher level. By some people, it is no longer looked at as a question of choice but as a question of morality, and these concepts have led to a full-blown debate over something that really should not be questioned. Every women in America has the right to decide what to do with their bodies. No government or group of people should feel that they have the right to dictate to a person what path their lives should take. People who say that they are "pro-life" are in effect no more than "anti-choice". These pro-lifers want to put the life and future of a women into the hands of the government. Abortion, and the choice a women may make, is a very private thing and should not be open to debate. The question of morality should not even come into play when considering abortion, because in this case the question is not of morality but of choice and constitutionality. The ninth amendment states "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people." This in turn, is guaranteeing a women the right to have an abortion. Pro-choice people say that abortion is the killing of a child, but pro-choice people do not consider the fetus a child. A philosopher, Mary Anne Warren, proposed that consciousness, reasoning, self-motivated activity, and self awareness are factors that determine 'person-hood'. But, a misconception that held is that people who are pro-choice are actually pro- abortion. Many people that support the right of a women to decide what to do with her own body may be personally against abortions. But, that does not mean that they think the government should be able to pass laws governing what females do with their bodies. Pro- choice people simply believe that it is the right of a women to assess her situation and decide if a baby would be either beneficial or deleterious to her present life. People that are against abortions do not take many things into consideration. One thing they do not consider is how the life of a teenager may be ruined if they are not given the option of abortion. Another thing not considered is the serious family strife that will result if a baby is forced to be born. Pro-lifers are adamant about their beliefs and think that they have an answer to every situation. Pregnant? Try adoption. Pregnant? They will help you support the baby. What ever the women's situation may be, pro-lifers will not change their stand. Many people that are pro-life suggest adoption as a viable alternative to abortion. But, in reality, this is not a good answer. The fact is is that the majority of people looking to adopt are middle class white couples. Another fact is is that most of the babies given up for adoption (or that are aborted) are of a mixed race. And, the truth is, is that most of the adopters do not want these type of children. This is a sad fact, but is true. Why else would adopting couples be placed on a waiting list for a few years when there are so many other kinds of babies out there. Would these pro-lifers rather see these children grow up as wards of the state, living a life of sorrow and misery? Pro-lifers are fighting for laws that will make abortion illegal. Do they really think that this will stop abortions? The only thing a law against abortions will accomplish will be to drive pregnant women to seek help in dark alleys and unsafe situations, resulting not only in the termination of the pregnancy, but perhaps their own lives as well. In the 1940's when abortion was illegal, there were still many cases of women seeking help elsewhere. The only difference though, is that these women usually ended up dead because of hemorrhaging or infection. If a woman wants an abortion, illegal or legal, nothing will stop her. Why would pro-lifers, who supposedly put so much value in life, want to endanger the live of another person? It is true that if a law is passed against abortion, it may serve to prevent some abortions. A women may not have enough money for an alley-way abortion and would then have to carry their pregnancy to term. The results of this could be disastrous. First of all, the mother would be depressed, probably would not get prenatal care, may drink, do drugs, or any other thing she could do to perhaps harm the life of the baby. And, when the baby finally is born, the mother may hate the baby, knowing that it has ruined her chance of ever accomplishing her goals in life. If these 'women forced into motherhood' do happen to keep their child, there is a good chance of child abuse and neglect. These unwanted children, raised by the state or unloving parents, would then give birth to another generation of unwanted children. Also, in some desperate situations, new mothers may have the idea that since they could not have an abortion they will kill their baby right after birth, perhaps with the idea that they would get away with it and be able to start their life afresh. When all of these situations are considered by an open-minded person, abortion seems the better of them. Radical pro-lifers fight for the lives of children and then go and destroy the lives of abortion doctors. Does this mean that they place more value on the live of a bundle of cells and tissues than they do on a human being? Contradictions such as these lead many pro-choice people to believe that pro-lifers are close-minded, immovable, radicals. Pro-lifers may say to all of these arguments that any of these situations would be preferable to abortion. The important thing, they believe, is that these children will be living. They say that when a women goes to get an abortion the fetus is given no choice. But, in effect, what they really are saying is that the power of choice should be taken away from the mothers, giving the unborn child an opportunity to be brought into a loveless, lonely, and uncaring world. f:\12000 essays\health & humanities (196)\Autism.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Autism Autism is one of the mental, emotional, and behavior disorders that appears in early childhood. Autism, or autistic disorder, almost always develops within the first 3 years of a child's life. Children and adolescents with autism cannot interact normally with other people. Autism thus affects many aspects of their development. Children with and adolescents with autism typically: -have a difficult time communicating with others -exhibit very repetitious behaviors (like rocking back and forth, head banging, or touching or twirling objects); -have a limited range of interests and activities; and -may became upset at a small change in their environment or daily routine. Although symptoms of autistic disorder sometimes can be seen in early infancy, the condition can appear after months of normal development. In most cases, it is not possible to identify any specific event that triggers autistic disorder. About 7 in every 10 children and adolescents with autistic disorder also have mental retardation or other problems with their brain function or structure. Recent studies estimate that as many as 14 children out of 10,000 may have autism or a related condition. About 125,000 Americans are affected by these disorders, and nearly 4,000 families across the country have two or more children with autism. Three times as many boys as girls have autism. Researchers are still unsure about what causes autism. Several studies suggest that autistic disorder might be caused by a combination of biological factors, including exposure to a virus before birth, a problem with the immune system, or genetics. Scientists also have identified chemicals in the brain and the immune system that may be involved in autistic disorder. As a normal brain develops, the level of serotonin, a chemical found in the brain, declines. In some children with autistic disorder, however, the serotonin levels do not decline. Now researchers are trying to determine whether this happens only to children with autism and why, and whether other factors are involved. f:\12000 essays\health & humanities (196)\autonomy v paternalism in mental health treatment.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AUTONOMY V PATERNALISM IN MENTAL HEALTH TREATMENT The assignment for this Ethics class was to review Mr. Jacob's treatment, as described by the New York State Commission on Quality of Care for the Mentally disabled (1994). The class was further asked to comment on the major issues for each of the three perspectives. The agencies, family and review board were to be included. This student will begin with a fourth perspective; that of Mr. Gordon. In the Matter of Jacob Gordon (1994), is the story of the last eight years of a psychiatrically disabled man's life. Mr. Gordon appeared to vacillate between striving for autonomy and accepting the support of his family. Unfortunately, it appeared by this account that the families support was not synonymous with autonomy. It did not appear that Mr. Gordon had ever desired or sought agency intervention for himself. Mr. Gordon's association with the mental health system appeared to be marked by power and control issues. "Consumers/ex-patients often report a feeling of "invisibility"; they sense that their views and desires do not matter (Carling, 1995, p.79 ). " The commission's report (1995) spoke of several incidences where Mr. Gordon eluded to his desire for autonomy. Mr. Gordon did not wish to live in a supervised setting. Mr. Gordon did not wish to attend group day treatment settings. Mr. Gordon did not wish to use medication in the treatment of his mental health disorder. Without medication his behavior was deemed unacceptable and did not permit him the opportunity to have any of these choices. "Choice is a right-not a privilege to be afforded by good behavior (Penny, 1994, p. 29)." Mr. Gordon's right of choice was limited even though he lived in his apartment independently. The condition of his apartment was scrutinized. His medication was closely monitored; sometimes to the degree that he was directed to leave his home to receive medication that was given to him crushed, in an attempt to insure it's ingestion. "Even peoples liberties in a highly controlled board and care home may be scarcely greater than in a hospital ward (Rubenstien, 1994, p.54)." In Mr. Gordon's case even within the sanctity of his own home, his liberties were scarcely greater than in a hospital ward. Other than his autonomy the second issue for Mr. Gordon appears to be the need for safety and support. For this, Mr. Gordon turned to his family. The report (1994) points out that Mr. Gordon requested his mother be limited in her ability to access personal information. He continued to need her support and assistance although this met she continued to be overly involved in his life. It was his mother he turned to when he had problems with a roommate. It was his mother who was utilized when Mr. Gordon was less compliant. It was Mr. Gordon's family who assured that he had continued mental health counseling and services. It was also Mr. Gordon's family who appeared to be the focal point of any plans for Mr. Gordon. "......expectations, soon to be dashed by programs more devoted to servicing neurotic families than people with schizophrenia" (Rubenstien, 1994, p.55). Mr. Gordon remained safe and close to his family by relinquishing his autonomy. Mr. Gordon's safety was the most important issue for the family. Secondarily to his safety, Mr. Gordon's family wished him to have the opportunity to participate in programming that would assist in his wellness. For Mr. Gordon's family, wellness seemed to equate to a standard of behavior that his mother personally viewed as normal. The family were not bound to any code of ethics or compelled to understand their biases or prejudices in their son's case. Certainly, to say that the family operated on the premise of paternalism is an understatement. Ethically, the Gordon's believed that they were the most justified to speak in the best interests of their son. The energy that the Gordon's put into advocating for what they believed, was in their son's best interest, is a testimony to the depth of the feelings they had for their son. The agencies primary issues appeared to be their liability and responsibility. Looking at the commission's report and attached responses from agencies (1995), it appears as though all of the agencies and practitioners involved were overly respectful of the involvement of Mr. Gordon's family. This over-involvement with Mr. Gordon's mother was understandable when it was disclosed that she had complained to state officials, whenever agencies did not respond in a way that she believed to be acceptable. It appears as though Mrs. Gordon understood very well, who to speak with and what to include as pertinent information, when she desired action. As the case proceeded, it became evident that Mrs. Gordon was the most active planner of her son's services. "Exaggerated fears and misconceptions associated with a lawsuit in high-risk clinical situations rarely bring out the best quality in practitioners.(Corey, Corey, & Callanan, 1993, p. 117). In actuality, the agencies involved were far more open to a lawsuit in terms of the lack of information that they choose to divulge to their client, Mr. Gordon. "A precaution of malpractice suit, is personal and professional honesty and openness with clients (Corey, et al., 1993, p.131)." Mr. Gordon never had the right to choose any of his treatment. He was never given all of the information concerning the selection of choices of services, or the possible consequences of his choices. Rooney (1992) points out the need for close scrutiny of ethics whenever agencies interfere with a client's autonomy. In an attempt to plan in Mr. Gordon's best interest, appease Mrs. Gordon and become less liable for any poor outcomes to the treatment plan, the agencies acted paternalisticly. Agencies imposed paternalism in each of the ways cited by Rooney (1992), by opposing Mr. Gordon's wishes of no medication. The agencies withheld information about the possible side effects of the medication he took, and the consequences of not taking medication. The agencies provided deliberate misinformation by allowing Mr. Gordon to believe that they were excluding his mother from the planning process. Agencies were also concerned with their own perceived responsibilities for Mr. Gordon's plan. Unfortunately, each agency choose to give as much responsibility as possible to Mr. Gordon's family. As the history of Mr. Gordon's treatment unfolded, it appeared evident that Mrs. Gordon was responsible for the development and supervision of Mr. Gordon's care. She coordinated all of the service providers, and was the main contact from one provider to the next. She became the "enforcer" for the plan, and who was ultimately consulted if Mr. Gordon refused to cooperate. As agencies became more controlling of Mr. Gordon's life (in response to Mrs. Gordon's concerns), Mr. Gordon became more non-compliant. "Ethical dilemmas arise when there are conflicts of responsibilities. For instance, when the agency's expectations conflict with the concerns or wishes of the clients (Corey et al., p.135)." It appears that toward the end of Mr. Gordon's life, none of the agencies were involved in a team approach in the delivery of services to this man. Each agency was involved in doing what they believed they were mandated to do for Mr. Gordon, and relied on Mrs. Gordon to coordinate and collaborate when necessary. The review board appeared to be most vested in singling out an agency to pronounce as responsible for the problems in the care of Mr. Gordon. Sundram (1994) writes of the changing paradigm from medical models of care to a client-centered approach to delivering services. Ironically, speaking on behalf of the same commission who wrote the review of Mr. Gordon, Mr. Sundram focuses on the need for changes within the rank and file of service providers to empower consumers. "We need to focus on ways to promote informed, voluntary choices of people with disabilities, to provide options that allow them to meet self-identified needs" (Sundram, 1994, p.8). Yet in its' report about Mr. Gordon (1995), the commission pointed out the agencies deficits in attempting to assure Mr. Gordon's medication compliance, and his compliance with exams necessary to remain safely on medication. Mr. Gordon was reported by the commission to have voiced his desire to discontinue any medication for his psychiatric disorder. The commission recommended that if family involvement becomes an issue that agencies deal with the families with the same diligence as other consumer issues. Yet, it appears that Mrs. Gordon had much more power than the consumer. Mrs. Gordon called the state office of mental health when she was dissatisfied. Agencies seem to have paid much diligent attention to this family. Yet, the commission and the Office of Mental Health believed that the family needed even a greater amount of attention within Mr. Gordon's care plan. Ironically, it seems that one of the families issues in the care of Mr. Gordon was his compliance with medication. The family advocated for agency involvement and paid for private psychiatric intervention. Dr. Surles (1994) the Commissioner of the Office of Mental Health writes a year prior to this report (1995), a compelling piece on the balance and contradictions of choice and safety. He clearly defines himself as a proponent for choice. Dr. Surles (1994) writes "We cannot demand that the public mental health system insure recipients choice and still guarantee recipients safety (p. 21)." "I simply want to note that, in the area of treatment, recipient choice means not just the right to refuse treatment, but the right to have access to treatment from which to choose (p. 22)". In responding to the concerns of Mrs. Gordon regarding her son's access to services, I am surprised that there is no mention by the commission to the message that agencies serving Mr. Gordon received from the Office of Mental Health's intervention. I further question the level of the Office of Mental Health's investigation into the choices of Mr. Gordon in relationship to his families wish for his safety. The commission appears to be desirous to place responsibility on agencies, for Mr. Gordon's choices. The flavor of this feels as unjust as the responsibility his family feels, and as unjust as the lack of choice Mr. Gordon felt. "Both professionals and recipients are trapped in a system that gives professionals too much responsibility and requires them to be accountable for too much (Penny, 1994, p.31)." The major conflict between the issues of choice, safety, liability, and responsibility is a philosophical conflict between autonomy and paternalism. Is freedom of choice a right that is truly inalienable and if so then should this right ever be abridged for paternalism? If choice is the right of every citizen than all parties involved in the case of Jacob Gordon acted in an unethical and/or immoral way. The family looked upon thier child as less than a human " To deny an individual's autonomy is to treat that person as less than human. (Atkinson, 1991, p.106)". The family was abusive to this person that they claimed was the object of their concern. Jacob was disrespectful and abusive to himself, in that he traded his autonomy for safety and belonging. "it is more important for humankind to exert free will, than it is to be contented (Atkinson, 1991, p.105)." In this regard, Mr. Gordon could be considered incompetent, since he was not interested in providing for himself the basic rights of his culture. The agencies involved with Mr. Gordon were unethical as: counselors "must recognize the need for client freedom of choice (Corey et al., p. 400)", psychologists "respect the rights of individuals to privacy, confidentiality, self-determination, and autonomy (Corey et al., p. 415)", and social workers " make every effort to foster maximum self- determination on the part of clients (Corey et al., p. 430)". The Commission on Quality of care was the most unethical, as it is the mission of this agency to "require providers and appropriate State agency officials to respond to the Commission findings, and to provide periodic reports on the implementation of Commission findings, and to provide periodic reports on the implementation of Commission recommendations ( Pamphlet, New York State Commission). The recommendations that suggested more supervision not only spoke to the issues of autonomy for Mr. Gordon, but for many other consumers served by the providers involved in this study and trained with this information. If paternalism is a societal obligation then Mr. Gordon was miserably under-served, and all parties involved in his care were irresponsible, unethical and liable for not keeping Mr. Gordon safe. The true measure of safety for Mr. Gordon would have been long term hospitalization where all of his needs could have been met. It is sad to read case studies of people struggling with normalizing life within a society that is uncertain of the issues involved in living with a psychiatric disability. My sympathy lies with Mr. Gordon, his family, and the providers involved with services for Mr. Gordon. I am sorry that the field of psychology is so tentative about the types of treatment that assist people in recovering from mental illness. Mr. Gordon certainly never appeared to be relieved from his symptoms to a degree that was comfortable during the years reported. His goals were aimed at normalizing his life, the same goals as every other player in this tragedy. Mr. Gordon's objectives in reaching that goal were at odds with the other members of his treatment team. The Gordon family certainly deserves recognition for the role they played in being available and supportive of Mr. Gordon's recovery. Mrs. Gordon seems the type of person that would have done anything to assist her son in his wellness, anything except risk harm to him. I empathize with her feeling of fear that her son was not receiving what he needed. The psychiatrist involved in Mr. Gordon's care seems to be rather mysterious, as we have little information about this provider. Frustration is inevitable when dealing month on end with a patient that shows little progress in diminishing the symptoms of his illness. Regardless of the amount of success therapy yielded the doctor never abandoned his client. As Mrs. Gordon was extremely pro-active in her son's treatment, the doctor's persistence was undoubtedly great. Lastly, the service providers worked reportedly countless hours to assist Mr. Gordon in becoming independent. In spite of the labyrinth of rules and regulations and concerns for conduct, these people gave Mr. Gordon unconditional care. The report reflects the maneuvering agency staff attempted to assist Mr. Gordon in accepting care that they believed would give him the lifestyle he wanted. I suspect that each of those agencies, at one time, gave Mr. Gordon all they could to assure his autonomy and his safety. Since these concepts do not mix, they worked in futile effort and likely were aware of this. Mr. Gordon's case will become important in the way services are delivered, when either the laws provide for consumers rights to choices and responsibilities, or agencies obligations to make choices and become responsible for the consumers safety. "Can' t you give me brains?" asked the scarecrow. "You don't need them. You are learning something everyday. A baby has brains, but it doesn't know much . Experience is the only thing that brings knowledge, and the longer you are on earth the more you are sure to get" The Wizard of Oz Frank L. Baum REFERENCE Atkinson, J. (1991). Autonomy and mental health. In P. Barker & S. Baldwin (Eds.), Ethical issues in mental health (pp.103-125). New York: Chapman & Hall. Carling, P.J. (1995). Return to Community Building Support Systems for People with Psychiatric Disabilities. New York: The Guilford Press. New York State Commission on Quality of Care for the Mentally Disabled, (1995). A Report. In The Matter of Jacob Gordon: Facing the Challenge of Supporting Individuals With Serious Mental Illness in the Community. New York: Commission on Quality of Care for the Mentally Disabled. New York State Commission on Quality of Care for the Mentally Disabled. A Pamphlet. What is The Commission? New York: Commission on Quality of Care for the Mentally Disabled. Corey, G., Corey, M.S., Callanan, P. (1993). Issues and Ethics in the Helping Professions. (4th ed.). California: Brook/Cole Publishing Co. Penny, D.J. (1994). Choice, common sense, and responsibility: the systems obligations to recipients. In C. J Sundram (Ed.), Choice & Responsibility (pp. 29-32). New York: NYS Commission on Quality of Care for the Mentally Disabled. Rooney, R. (1992). The ethical foundation for work with involuntary clients. Strategies for Work with Involuntary Clients. (pp. 53-74). New York: Columbia University Press. Sundram, C.J. (1994). A framework of thinking about choice and responsibility. In C. J. Sundram (Ed.), Choice & Responsibility (pp. 3-16). New York: NYS Commission on Quality of Care for the Mentally Disabled. Surles, R.C. (1994). Free choice, informed choice, and dangerous choices. In C.J. Sundram (Ed.), Choice & Responsibility (pp. 17-24). New York: NYS Commission on Quality of Care for the Mentally Disabled. f:\12000 essays\health & humanities (196)\BetaCarotene.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ BETA-CAROTENE Beta-carotene is a member of the carotenoid family and has over 500 relatives. Carotenoids are yellow-to-red pigments found in all green plant tissues and in some species of algae. So far 21 different carotenoids have been found in human blood. The most abundant ones are alpha-carotene, beta-carotene, lutein, lycopene, cryptoxanthin and zeaxanthin. A molecule of alpha-carotene, beta-carotene, or cryptoxanthin can be split into two molecules of vitamin A in the body but the conversion of beta-carotene is by far the most effective. The six carotenoids are all antioxidants. They are very effective in neutralizing a highly reactive for of oxygen called singlet oxygen but also, to some extent, act to break up the chain reactions involved in lipid peroxidation. Numerous studies have shown that people who consume a diet rich in dark yellow orange vegetables (carrots) and dark green vegetables (broccoli) are much less likely to develop cancer and heart disease. It has also been established that people with low levels of beta-carotene in their blood have a higher incidence of heart disease and cancer, particularly lung cancer. The National Cancer Institute endorsed a study which found that women who consume lots of beta-carotene rich fruits and vegetables have a lower chance of getting cancer, including breast cancer. The Institution says that regularly eating lots of fruits and vegetables plays a key roll in cancer prevention, but whether the preventative action comes from beta-carotene or other nutrients in the produce has yet to be determined. For people who don't like eating their fruits and vegetables, a beta-carotene supplement pill was introduced into the market. Millions of vegetable hating Americans hoped that by taking a pill instead of eating vegetables, they could get the same rewards as their counterparts who enjoy the taste of fruits and vegetables. But officials at the National Cancer Institute released the results of two large studies designed to put the benefits of beta-carotene supplements to the test. One followed 22,071 doctors who for 12 years smokers had to be stopped prematurely because it seemed to me making the rate of death from cancer and heart disease worse. Taking a simple chemical supplement is not the same as eating a vegetable. Scientists suspect there are other natural ingredients that work with vitamins to promote health. It is also possible that a beta-carotene supplement derived from natural sources and formulated so as to preserve the normal carotene ratio in the blood may be of benefit for people at high risk for cancer and cardiovascular disease. This, however, needs to proven. So, until the remaining riddles in the carotene puzzle are solved, the prudent course of action is to avoid smoking and exposure to second-hand smoke and to increase the intake of vegetables and fruits. In 1981 it was suggested that beta-carotene is the active component in the protective vegetables and that supplementing with beta-carotene might prevent certain cancers. The idea was based on the fact that took 50 mg of beta-carotene every other day. Another involved 18,314 smokers, ex-smokers, and asbestos workers. Not only did beta carotene produce no measurable health benefits, but the study of beta-carotene is an antioxidant and the most abundant carotenoid in vegetables. There was also considerable evidence to the effect that vitamin A prevents or retards certain cancers, so that beta-carotene is readily converted to vitamin A in the liver and intestine was seen as an added bonus. More recent research suggests that beta-carotene's prevention effect is due to its antioxidant property rather than to its ability to form vitamin A. People need to learn to take a little bit of time to eat good, healthy foods instead of relying on pills. I feel that more people need to be educated about what beta carotene can do for you. If more people ate enough beta-carotene, maybe doctors would have less patients to treat. Beta-Carotene really can help prevent a lot of diseases. It's almost like a natural life-saver. Now I understand why my parents are always telling me to "eat my vegetables, they are good for you." SOURCES 1. "Beta-Carotene: A Nugget of Nutritional Gold.", Marilyn Carnell, Ph.D., R.D Better Homes and Gardens, October 1992: 64-66. 2. "Beta No More", Christine Gorman. Time Magazine, Jan. 29, 1996: pg. 66. 3. Peto , R, et al. Can dietary beta-carotene materially reduce human cancer rates? Nature, Vol. 290, March 19, 1981, pp. 201-208. f:\12000 essays\health & humanities (196)\Beyond Kevorkian A True Look At Doctor Assisted Suicide.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ In thousands of homes across the nation victims of terminal illnesses sit in pain due to their sicknesses. Should these people have to go through all of that pain and suffering just for the end result of death? Should these people have the right to assisted death, to rid themselves of unbearable pain? This topic has been one of the great controversies over the last several years. Not too long ago if someone was found assisting in suicide, it was seen as a felony crime. But recently there have been court cases taken up in two federal appellate courts that ruled terminally ill patients have the right to seek doctor assisted suicide (Carter 1). These cases took place in New York and Washington. This added two more to the list of states that legalized this means of ending life. However, doctor assisted is still seen as a criminal act in thirty four states(Rosen 1). In my opinion, doctor assisted suicide should be made legal throughout the nation. If a terminally ill patient wants to take his or her life due to excruciating pain, he or she should have the ability to utilize euthanasia. Ultimately, the decision should be that of the terminally ill individual. The main controversy over this issue, is the question of morality. Is it morally right for a doctor to assist in suicide? Many individuals feel that it is not. It is thought if assisted suicide is legalized throughout the states, it will encourage families with terminally ill relatives to push them prematurely to their demise(Carter 2). This is an outlandish assumption. A family that truly loves one another would not urge a family member to rush any decision as momentous as ending one's life. If there is caring among the family, the suicide would not take place until is was utterly necessary. Two other important moral questions also arise from this issue. First, do our mortal lives belong to us alone, are we sovereign over our bodies, or do they belong to the communities of families in which we are embedded? Second, will this right give the terminally ill a greater sense of control over their circumstances, or will it weaken respect for life?(Carter 2) The first question is ridiculous. It seems as though Carter is trying to say we will no longer be in charge of ourselves, and we will be living in a socialistic society. There is no reason why we should not be able to control the destiny of our lives. We, as human beings, are solely sovereign over our own bodies. Therefore, it is the terminally ill patient who should have the ability to choose death over life. It is this person who is experiencing the pain and suffering of their disease, not a relative or close friend, much less the government. The legalization of doctor assisted suicide is no reason to change anything with people who are not terminally ill. The second question, on the other hand, has some validity and logic to it. Doctor assisted suicide would give the dying a certain sense of control. It would enable the patient to have a certain feeling of power, knowing that he or she has the ability to complete his or her life upon request. This may sound somewhat awkward; however, it is quite possible that it would give the patients a sense of well being. Furthermore, it gives them a chance to end their lives on their terms, instead of letting a disease determine their course in life. As for the second half of this question, it should in no way weaken the respect for life. Losing respect for life is for the weak minded. If anything it strengthens the patient's respect; a person in the last stages of a terminal illness has endured some of the worst life has to offer. It takes away many of his capabilities to perform what would normally be commonplace activities; in short it has overtaken his life and dignity. The ability to perform legal assisted suicide would help to replace some of the dignity which the illness has extracted from a person's life. It would give the person the capability to end matters on his own terms. John Stuart Mill, one of the great philosophers of the nineteenth century, derived a theory which is an excellent example as an argument for the legalization of doctor assisted suicide, or all moral crimes for that matter. This theory was deemed the "Harm Principle": a person is wholly sovereign over his body. It is no one else's right to invade a person's body. Therefore, since one is fully autonomous over his physical body, one should have the ability to do as he pleases with it. This holds true up until the point where his actions bring harm to another human. Doctor assisted suicide is a perfect example, one's body is his own and only his; therefore, if one chooses not to suffer needlessly for months or even years who is to stop him from utilizing the procedure? Some would argue that this does cause harm to others in an emotional sense, yet this is not the issue, and not how Mill thought it should be interpreted. Now that the moral issues have been discussed, what about the rights which the Constitution of the United Stated guarantees its citizens? Under the provisions of the fourteenth amendment, the same amendment the right to abortion is found under, we are provided the right to due process(Carter 1). The argument set forth here, is the fact that not all states abide by this amendment, thirty four to be exact. The reason for this is, they do not feel the "right to die" means allowing a doctor to assist terminally ill patients in prematurely ending their lives. Another reason is the assumption that, if doctor assisted suicide were legalized, it could possibly be used as an excuse for murder(America 1). It is possible that it could occur; however, self defense is also an excuse that is used from time to time. But this excuse does not always work. If a murder case was taken to court for "assisted suicide", it would be justly proven whether it was an act of murder, or, rather, whether it was an act of mercy. The federal rulings state, "we see no real difference between allowing terminally ill patients to die naturally and taking direct measures to kill them."(America 1) I am in total agreement with their statement. However, I am against what happened to a man by the name of Aaron McGuinn. In 1990 this man tested positive for the HIV virus, and in 1996 he passed away by the means of assisted suicide(Macleans). However, he was not yet suffering, for he had not yet developed full blown AIDS, and was in no pain at all. This decision goes against my personal morals for doctor assisted suicide. Finally, I support doctor assisted suicide, but only within certain limitations. First, the patient must be within close proximity to a natural death, and this should be documented by a licensed physician. If a patient is in unbearable pain, then it is also understandable to follow through with the procedure. This decision should not be taken lightly in any way, and if it were to become decriminalized, there should be some type of counseling service established for those who are weighing their options with doctor assisted suicide. A person's body is his own and his alone; therefore, when it is all said and done, it should be he who is in full control of his own destiny. f:\12000 essays\health & humanities (196)\Bipolar theory.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The phenomenon of Bipolar Affective Disorder has been a mystery since the 16th and 17th century. The Dutch painter Vincent Van Gogh was thought to of suffered from bipolar disorder. It appears that there are an abundance of people with the disorder yet, no true causes or cures for the disorder. Clearly the Bipolar disorder severely undermines their ability to obtain and sustain social and occupational success. However, the journey for the causes and cures for the Bipolar disorder must continue. Affective disorders are primarily characterized by depressed mood, elevated mood or (mania), or alternations of depressed and elevated moods. The classical term is manic-depressive illness, a newer term is Bipolar disorder. The two are interchangeable. Milder forms of a depressive syndrome are called dysthymic disorder, mild forms of mania are hypomania and the milder expressions of Bipolar disorder are called cyclothymic disorders. The use of the term primary affective disorder refers to the individuals who had no previous psychiatric disorders or else only episodes of mania or depression. Secondary affective disorder refers to patients with preexisting psychiatric illness other than depression or mania (Goodwin, Guze. 1989, p.7 ). Bipolar affective disorder affects approximately one percent or three million persons in the United States, afflicting both males and females. Bipolar disorder involves episodes of mania and depression. The manic episodes are characterized by elevated or irritable mood, increased energy, decreased need for sleep, poor judgment and insight, and often reckless or irresponsible behavior (Hollandsworth, Jr. 1990 ). These episodes may alternate with profound depressions characterized by a pervasive sadness, almost inability to move, hopelessness, and disturbances in appetite, sleep, in concentrations and driving. Bipolar disorder is diagnosed if an episode of mania occurs whether depression has been diagnosed or not (Goodwin, Guze, 1989, p 11). Most commonly, individuals with manic episodes experience a period of depression. Mood is either elated, expansive, or irritable, hyperactivity, pressure of speech, flight of ideas, inflated self esteem, decreased need for sleep, distractibility, and excessive involvement in activities with high potential for painful consequences. Rarest symptoms were periods of loss of all interest and retardation or agitation (Weisman, 1991). As the National Depressive and Manic Depressive Association (MDMDA) has demonstrated, bipolar disorder can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters. This devastating disease causes disruptions of families, loss of jobs and millions of dollars in cost to society. Many times bipolar patients report that the depressions are longer and increase in frequency as the individual ages. Many times bipolar in a psychotic state are misdiagnosed as schizophrenic. Speech patterns help distinguish between the two disorders (Lish, 1994). The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years of age, with a second peak in the mid-forties for women. A typical bipolar patient may experience eight to ten episodes in their lifetime. However, those who have rapid cycling may experience more episodes of mania and depression that succeed each other without a period of remission (DSM III-R). The three stages of mania begins with hypomania, which patients report that they are energetic, extroverted and assertive. The hypomania state has let observers to feel that bipolar patients are "addicted" to their mania. Hypomania progresses into mania as the transition is marked by loss of judgment. Often, euphoric grandiose characters are recognized as well as a paranoid or irritable character begins to manifest. The third stage of mania is evident when the patient experiences delusions with often paranoid themes. Speech is generally rapid and behavior manifests with hyperactivity and sometimes assaultiveness. When both manic and depressive symptoms occur at the same time it is called a mixed episode. These people are a special risk because of the combination of hopelessness, agitation and anxiety make them feel like they "could jump out of their skin"(Hirschfeld, 1995). Up to 50% of all patients with mania have a mixture of depressed moods. Patients report feeling very dysphoric, depressed and unhappy yet exhibit the energy associated with mania. Rapid cycling mania is yet another presentation of bipolar disorder. Mania may be present with four or more distinct episodes within a 12 month period. There is now evidence to suggest that sometimes rapid cycling may be a transient manifestation of the bipolar disorder. This form of the disease experiences more episodes of mania and depression than bipolar. Lithium has been the primary treatment of bipolar disorder since its introduction in the 1960's. It is main function is to stabilize the cycling characteristic of bipolar disorder. In four controlled studies by F. K. Goodwin and K. R. Jamison, the overall response rate for bipolar subjects treated with Lithium was 78% (1990). Lithium is also the primary drug used for long- term maintenance of bipolar disorder. In a majority of bipolar patients, it lessens the duration, frequency, and severity of the episodes of both mania and depression.Unfortunately, there are up to 40% of bipolar patients who are either unresponsive to lithium or who cannot tolerate the side effects. Some of the side effects include thirst, weight gain, nausea, diarrhea, and edema. Patients who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder (those patients who experience at least four distinct episodes within one month period). Among the problems associated with lithium includes the fact the long-term lithium treatment has been associated with decreased thyroid functioning in patients with bipolar disorder. Preliminary evidence also suggest that hypothyroidism may actually lead to rapid-cycling (Bauer et al., 1990). Another problem associated with the use of lithium is its use by pregnant women. Its use during pregnancy has been associated with birth defects, particularly Ebstein's anomaly. Based on current data, the risk of a child with Ebstein's anomaly being born to a mother who took lithium during her first trimester of pregnancy is approximately 1 in 8,000, or 2.5 times that of the general population (Jacobson et al., 1992). There are other effective treatments for bipolar disorder that are used in cases where the patients cannot tolerate lithium or can become unresponsive to it in the past. The American Psychiatric Association's guidelines suggest the next line of to be anticonvulsant such as valproate and carbamazepine. These drugs are useful as antimanic agents, especially in those patients with mixed states. Both of these medications can be used in combination with lithium or in combination with each other. Valproate is especially helpful for patients who are lithium noncompliant, experience rapid-cycling, or have comorbid alcohol or drug abuse. Neuroleptics such as haloperidol or chlorpromazine have also been used to help stabilize manic patients who are highly agitated or psychotic. Use of these drugs is often necessary because the response to them are rapid, but there are risks involved in their use. Because of the often severe side effects, benzodiazepines are often used in their place. Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms of rapid control of agitation and excitement, without the severe side effects. Antidepressants such as the selective serotonin reuptake inhibitors (SSRIs) fluovamine and amitriptyline have also been used by some doctors as treatment for bipolar disorder. A double-blind study by M. Gasperini, F. Gatti, L. Bellini, R.Anniverno, and E. Smeraldi showed that fluvoxamine and amitriptyline are highly effective treatments for bipolar patients experiencing depressive episodes. This study is controversial, however, because conflicting research shows that SSRIs and other antidepressants can actually precipitate manic episodes. Most doctors can see the usefulness of antidepressants when used in conjunction with mood stabilizing medications such as lithium. In addition to the mentioned medical treatments of bipolar disorder, there are several other options available to bipolar patients, most of which are used in conjunction with medicine. One such treatment is light therapy. One study compared the response to light therapy of bipolar patients with that of unipolar depresses patients. Patients are free of psychotropic and hypnotic medications for at least one month before treatment. Bipolar patients in this study showed an average of 90.3% improvement in their depressive symptoms, with no incidence of mania or hypomania. They all continued to use light therapy, and all showed a sustained positive response at a three month follow-up (Hopkins and Gelenberg, 1994). Another study involved a four week treatment of morning bright light treatment of patients with seasonal affective disorder, including bipolar patients. This study found a statistically significant decrement in depressive symptoms, with the maximum antidepressant effect of light not being reached until week four. Hypomanic symptoms were experienced by 36% of bipolar patients in this study. Predominant hypomanic symptoms included racing thoughts, deceased sleep and irritability. Surprisingly, one-third of controls also developed symptoms such as those mentioned above. Regardless of the explanation of the emergence of hypomanic symptoms in undiagnosed controls, it is evident from this study that light treatment may be associated with the observed symptoms. Based on the results, careful professional monitoring during light treatment is necessary, even for those without a history of major mood disorders. Another popular treatment for bipolar disorder is electro-convulsive shock therapy. ECT is the preferred treatment for severely manic pregnant patients and patients who are homicidal, psychotic, catatonic, medically compromised, or severely suicidal. In one study, researchers found marked improvement in 78% of patients treated with ECT, compared to 62% of patients treated only with lithium and 37% of patients who received neither, ECT or lithium (Black et al., 1987). A final type of therapy that I found is outpatient group psychotherapy. According to Dr. John Graves, spokesperson for The National Depressive and Manic Depressive Association have called attention to the value of support groups, challenging mental health professionals to take a more serious look at group therapy for the bipolar population. Research shows that group participation may help increase lithium compliance, decrease denial regarding the illness, and increase awareness of both external and internal stress factors leading to manic and depressive episodes. Group therapy for patients with bipolar disorders responds to the need for support and reinforcement of medication management, the need for education and support for the interpersonal difficulties that arise during the course of the disorder References Bauer, M.S., Kurtz, J.W., Rubin, L.B., and Marcus, J.G. (1994). Mood and Behavioral effects of four-week light treatment in winter depressives and controls. Journal of Psychiatric Research. 28, 2: 135-145. Bauer, M.S., Whybrow, P.C. and Winokur, A. (1990). Rapid Cycling Bipolar Affective Disorder: I. Association with grade I hypothyroidism. Archives of General Psychiatry. 47: 427-432. Black, D.W., Winokur, G., and Nasrallah, A. (1987). Treatment of Mania: A naturalistic study of electroconvulsive therapy versus lithium in 438 patients. Journal of Clinical Psychiatry. 48: 132-139. Deltito, J.A., Moline, M., Pollak, C., Martin, L.Y. and Maremani, I. (1991). Effects of Phototherapy on nonseasonal unipolar and bipolar depressive spectrum disorders. Journal of Affective Disorders. 23: 231-237. Fawcett, Jan. (1994). Bipolar depression highlights of the first international conference on bipolar disorder. University of Pittsburgh, Pennsylvania. Forster, P.L. Videoconference program synopsis. Annenburg Center for Health Services at Eisenhower Rancho Mirage, C.A. (http://www.wpic.pitt.edu/research/stanley/othnws/vidtel12.htm). Gasperini, M., Gatti, F., Bellini, L., Anniverno, R., Smeralsi, E., (1992). Perspectives in clinical psychopharmacology of amitriptyline and fluvoxamine. Pharmacopsychiatry. 26:186-192. Goodwin, F.K., and Jamison, K.R. (1990). Manic Depressive Illness. New York: Oxford University Press. Goodwin, Donald W. and Guze, Samuel B. (1989). Psychiatric Diagnosis. Fourth Ed. Oxford University. p.7. Hirschfeld, R.M. (1995). Recent Developments in Clinical Aspects of Bipolar Disorder. The Decade of the Brain. National Alliance for the Mentally Ill. Winter. Vol. VI. Issue II. Hollandsworth, James G. (1990). The Physiology of Psychological Disorders. Plenem Press. New York and London. P.111. Hopkins, H.S. and Gelenberg, A.J. (1994). Treatment of Bipolar Disorder: How Far Have We Come? Psychopharmacology Bulletin. 30 (1): 27-38. Jacobson, S.J., Jones, K., Ceolin, L., Kaur, P., Sahn, D., Donnerfeld, A.E., Rieder, M., Santelli, R., Smythe, J., Patuszuk, A., Einarson, T., and Koren, G., (1992). Prospective multicenter study of pregnancy outcome after lithium exposure during the first trimester. Laricet. 339: 530-533. Lish, J.D., Dime-Meenan, S., Whybrow, P.C., Price, R.A. and Hirschfeld, R.M. (1994). The National Depressive and Manic Depressive Association (DMDA) Survey of Bipolar Members. Affective Disorders. 31: pp.281-294. Weisman, M.M., Livingston, B.M., Leaf, P.J., Florio, L.P., Holzer, C. (1991). Psychiatric Disorders in America. Affective Disorders. Free Press. University of Pittsburgh, Pennsylvania. (1994). Bipolar depression highlights of the first international conference on bipolar disorder. (http://www.wpic.pitt.edu/research/bipolar2.htm). f:\12000 essays\health & humanities (196)\Breach of confidentiality the legal implications when you ar.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Breach of Confidentiality: The legal Implications when You are seeking Therapy Abnormal Psychology 204 November 2, 1996 Breach of Confidentiality: The legal Implications when You are seeking Therapy I. The need for confidentiality in therapy A. Establish trust B. A patients bill of rights Thesis: The duty to warn has created an ethical dilemma for psychological professionals. II. Therapists face a moral problem B. Requirement by law to breach confidentiality C. Exceptions for breaching confidentiality D. Prediction of violence E. Impact on client I. The future outlook for therapy A. Conflicting views between the legal and psychological professions Breach of Confidentiality: The legal Implications when You are seeking Therapy People are afraid to admit to themselves and others that they need to help to resolve their psychological problems. This is due to the social stigma which society attaches to people, when they seek assistance from a mental health professional. Consequently it is very difficult for any person to establish a trusting relationship with their therapist, because they fear, that the therapist might reveal their most personal information and emotions to others. Health professionals therefore created the patients bill of rights to install confidence between clients and therapists. The patient has a right to every consideration of privacy concerning his own medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present. The patient has the right to expect that all communications and records pertaining to his care should be treated as confidential. ( Edge, 63 ) This bill of rights enables clients to disclose all personal information without fears. To fully confide in the therapist is essential to the success of the therapy. On the other hand, the therapist is legally obliged to breach this trust when necessary. The duty to warn has created an ethical dilemma for psychological professionals. The duty to warn is based on a court ruling in 1974. Tatiana Tarasoff was killed by Prosenjit Poddar. Prior to the killing Poddar had told his therapist that he would kill Tatiana upon her return from Brazil. The psychologist tried to have Poddar committed, but since the psychiatrist overseeing this case failed to take action, Poddar was never committed nor was Tarasoff warned about Poddars intentions to kill her. This failure resulted in Tatianas death. The Supreme Court therefore ruled that the psychologist had a duty to warn people which could possibly become harmed ( Bourne, 195-196 ). This policy, to warn endangered people, insures that therapists must breach there confidentiality for specific reasons only. These few exceptions are: ? Harm Principle: "When the practitioner can foresee a danger to an individual who is outside the patient/provider relationship, potentially caused by the patient, the harm principle provides the rationale for breaching confidentiality to warn the vulnerable individual " ( Edge, 63 ). ? "When the client is a potential danger to himself or herself" ( Bourne,487 ). ? "If the client is a criminal defendant and uses insanity as a defense" ( Bourne, 487 ). ? "If the client is underage and the therapist believes that he or she is the victim of a crime (such as child abuse)" ( Bourne, 487 ). The breach for a clients insanity defense would have been helpful in deciding a famous court case in 1843: the McNaghten's case. McNaghten used the insanity defense, when he was faced with the charge of killing Sir Robert Peele's private secretary. A jury had to decide, if he was conscious of the act or if he was temporary insane ( McCarty, 299-300 ). The jury clearly didn't have the professional training to make a competent decision. How did they establish if McNaghten knew right from wrong at the time of the crime? Therefore they were incompetent when deciding that he, indeed, was temporarily insane. Now these determinations are made by qualified mental health professionals. Nevertheless other obstacles are still being encountered. In the beginning the law provides clear guidelines when to breach confidentiality. The Harm Principle is one of the guidelines. But how can a therapist absolutely determine, that a client presents harm to another individual? "To say that someone is dangerous is to predict future behavior. The rarer an event, the harder it is to predict accurately. Hence if dangerousness is defined as homicide or suicide, both of which are rare events, the prediction of dangerousness will inevitably involve many unjustified commitments as well as justified ones" ( Alloy, 570 ). The therapist must predict the capacity for violence in the client. There are no guidelines to establish such a diagnose. "... All that is mandated by the opinion is that the therapist "exercise that reasonable degree of skill, knowledge, and care ordinarily possessed and exercised by members of [their particular profession] under similar circumstances... Within the broad range of reasonable practice and treatment in which professional opinion and judgment may differ, the therapist is free to exercise his or her own best judgment without liability; proof aided by hindsight, that he or she judged wrongly is insufficient to establish negligence" ( Annas, 198 ). The therapist is faced with an immense challenge. He has to rely onto himself or herself only. Only aided by his or her professional training to evaluate the client and taught and /or self-learned ethics to depend on. Adding the fact that the clients future rests on his judgment, the amount of pressure and stress can only be imagined. As if this predicament isn't already difficult enough for the therapist, more obstructions have to be conquered to make a qualified determination of the clients dangerousness. A therapists prediction is like a mathematical equation with many known and unknown variables. There are four unknown factors involved in the decision-making process: 1. Lack of corrective feedback. When clients become committed to a mental facility, because they were considered harmful, we cannot discover if this person would constitute a danger to others if discharged. 2. Differential consequences to the predictor. Wrongfully discharged individuals which are discovered to be harmful (false negatives) cause extremely negative publicity. Wrongfully committed harmless individuals (false positives) don't cause that kind of publicity. 3. Unreliability of the criterion. The only concrete indication for forecasting a clients violence is a prior record of encountered violence, which might be questionable. 4. Powerlessness of the subject. Until not long ago, wrongfully accused and then committed individuals had few rights to fight this wrongful decision ( Alloy, 571-572 ). "All of these factors encourage mental health professionals to err in the direction of overpredicting dangerousness. Do they in fact do so? Studies of predictions of dangerousness have yielded far more false positives than false negatives" ( Alloy, 572 ). When a therapist makes an erroneous decision based on these factors, he cannot be held liable, since he or she cannot know how truthful all evidence represents a clients state of mind. However should a therapist be punished for making too many incorrect warnings, because he or she is in constant distress about his or her legal liability? "... and therefore to protect themselves against liability imposed by a duty to disclose, therapists are likely to make many warnings" ( Annas, 197-198 ). The dictated responsibility to protect the public by "blowing the whistle" on their clients can lead a therapist to view differently how to conduct their therapy sessions with clients. How non-judgmental can a therapist remain, when ordered by our legal system, to choose the well-being of the public over his or her clients well-being ? What impact will this have on the clients behavior? Gaining and upholding a clients trust is a most difficult task for the therapist. Especially because a client never completely loses his or her fear that a therapist might disclose certain or all personal information to a third party. When the client becomes aware of the fact, that the therapist is legally obligated to disclose certain case information in order to prosecute or commit the client if necessary, commonly the client will not seek therapy or abandon current therapy to avoid possible negative consequences. "These warnings are likely to cause their patients to terminate treatment and possibly act out their aggressive impulses" ( Annas, 198 ). Seldomly will distressed individuals regain their mental health without professional help. Since they do not wish to receive assistance, due to the possibility of legal repercussions, they often follow a detrimental path. Finding themselves unable to resist their urges, they act out their aggressiveness. The targeted person gets harmed, or even worse, killed. Therapists therefore argue that a sharp increase in involuntary commitments and preventable crimes will be the secondary, long-term result of the imposed duty to warn. Conflicting views between the legal and psychological professions have always existed. This is due to the nature of these opposite professions. The legal community restricts their views to verifiable, concrete, therefore empirical evidence only. The psychological community however cannot be that rigid. Mental health professionals deal with facts (reality), but they also have to deal with their clients emotions, beliefs and irrational beliefs. Empathy and trustworthiness play an important role when counseling clients. Courts and mental health professionals have something in common, they both try to protect the welfare of others. Legal practitioners look out for the well-being of the general population. This next statement perfectly reflects their view: Hospitals and the medical sciences, like other public institutions and professions, are charged with the public interest. Their image of responsibility in our society makes them prime candidates for con- verting their moral duties into legal ones. Noblesse Oblige ( Annas, 199 ). Mental health practitioners however focus on the well-being of the individual. To protect and serve the general population as commanded by the courts created an ethical dilemma for psychological professionals. The courts force them to act contradicting to their professional beliefs and ethics. Therapists reason that when they must serve the public they cannot successfully treat their clients. Or how can they treat an individual at all, if the person won't consider entering therapy do to the possibly grim consequences ? Highly advanced communication devises erode our personal privacy more every day. Now the court system seems to follow this trend. Therapists are trying to fight these developments and question the true motives of the court system. More research has to be conducted to find better alternatives. Maybe this ethical dilemma can be resolved in the future, maybe more ethical dilemmas will surface. We are all individuals and should be treated with our own individual interests in mind. Maybe we should indulge in more economic thinking, to fuse the well-being of the individual with the well-being of the general population and thereby eliminating the ethical dilemma. Economic theory can verify, that when individuals act in their own best self-interest, the population as a whole will benefit from it, too. This economic principle also applies to psychology. References Alloy, L. B., Acocella, J., Bootzin, R. R. ( 1996 ) . Abnormal psychology . USA: McGraw-Hill . Annas, G. J. ( 1988 ) . Judging medicine . New Jersey: Humana Press . Bourne, L. E., Jr., Ekstrand, B. R. ( 1985 ) . Psychology: Its principles and meanings USA: Holt, Rinehart and Winston . Edge, R. S., Groves, J. R. ( 1994 ) . The ethics of health care . USA: Delmar Publishing . McCarty, D. G. ( 1967 ) . Psychology and the law . New Jersey: Prentice-Hall Breach of Confidentiality: The legal Implications when You are seeking Therapy I. The need for confidentiality in therapy A. Establish trust B. A patients bill of rights Thesis: The duty to warn has created an ethical dilemma for psychological professionals. II. Therapists face a moral problem B. Requirement by law to breach confidentiality C. Exceptions for breaching confidentiality D. Prediction of violence f:\12000 essays\health & humanities (196)\Breast Cancer Treatments.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Breast Cancer Treatment Only lung cancer kills more women each year in the United States than breast cancer does. The American Cancer Society (ACS) estimates that over 184,000 new cases of breast cancer were diagnosed in women in 1996 (ACS Breast). Although these statistics are alarming, there are a number of treatment options available for those that are diagnosed with breast cancer. The best way to treat any disease is to prevent it. Since little is known about breast cancer, there are no established rules for prevention. The ACS recommends that women age twenty and older perform monthly breast self-exams, and it also suggests clinical examinations every three years (ACS Breast). Mammography is also a wonderful tool for detecting tumors; however, there is conflicting data on when and how often women should have mammograms. What is known is that mammography is the best way to determine if a palpable lump is actually cancerous or not. Treatment methods for breast cancer can be lumped in two major categories; local or systemic. Local treatments are used to destroy or control the cancer cells in a specific area of the body. Surgery and radiation therapy are considered local treatments. Systemic treatments are used to destroy or control cancer cells anywhere in the body. Chemotherapy and hormonal therapy are considered systemic treatments. Surgery is the most common treatment for breast cancer. Although there are many different types of breast cancer surgery, they all fit into a few basic categories. An operation that aims to remove most or all of the breast is called a mastectomy. If at all possible, doctors shy away from mastectomies due to the side effects which include loss of strength in the closest arm, swelling of the arm, and limitation of shoulder movement. If a mastectomy must be performed, the physician will often suggest post surgical reconstruction of the breast (Kushner 37). Another type of breast cancer surgery is called breast-sparing surgery. This category would include lumpectomies and segmental mastectomies. In this situation, doctors remove only the tumor and make an attempt at sparing the rest of the breast tissue. These procedures are often followed by radiation therapy to destroy any cancer cells that may remain in the area. In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system. Radiation therapy is another common treatment for breast cancer. Radiation involves the use of high-energy x-rays to damage cancer cells and retard further growth. The radiation may come from a radioactive source outside the body, or it can come from radioactive pellets placed directly in the breasts. It is not uncommon for a patient to receive both internal and external radiation. For external radiation, patients must visit the hospital or clinic each day. When this regimen follows breast-sparing surgery, the treatments are given five days a week for five to six weeks. At the end of that time, an extra "boost" of radiation is often given to the place where the tumor was removed. Hospital stays are required for implant radiation. Some common side effects of radiation therapy include swelling of the breast and dry skin at the radiation site. Chemotherapy is one of the systemic therapies doctors use to fight breast cancer. Chemotherapy uses drugs to kill cancer cells, and it usually involves a combination of those drugs. Traditional chemotherapy is administered in cycles; a treatment period followed by a recovery period, then another treatment, and so on (NIH 23). Like radiation therapy, chemotherapy can be administered on an outpatient basis. Although chemotherapy works to kill cancer cells, some of the side effects almost make treatment unbearable. Common side effects include nausea, decrease of appetite, hair loss, vaginal sores, infertility, and fatigue (ACS For Women 32). Most of these effects, except infertility, cease when the treatment is over. There are many other possible treatments for breast cancer that are currently under study. One of the biggest clinical trials involves hormone therapy. This treatment uses medication to prevent the tumors from getting the hormones, such as estrogen, that they need to thrive. Removal of the ovaries and other hormone producing glands may also be prescribed. Another treatment option being studied is bone marrow transplantation. The bone marrow can be taken from healthy parts of the patient's own body or from other donors. Although this treatment idea is still in its early stages, the results seem promising. Because there are so many varied treatment options, treatment decisions are complex. These decisions are often affected by the judgment of the doctors involved and the desires of the patient. A patient's treatment options depend on a number of factors. These factors include age, menopausal status, general health, the location of the tumor, and the size of the breasts (ACS Breast). Certain features of the tumor cells, such as whether they depend on hormones to grow, are also considered. The most important factor in determining treatment is the stage of the disease. Stages are based on the size of the tumor and whether it has spread to other tissues. Stage I and stage II are considered the early stages of breast cancer. Stage I implies that cancer cells have not spread beyond the breast and the tumor is no more than an inch in diameter. Stage II means that the cancer has spread to underarm lymph nodes and/or the tumor in the breast is one to two inches in diameter. Women with early stage breast cancer may have breast-sparing surgery followed by radiation as their primary local treatment, or they may have a mastectomy. These approaches are equally effective in treating early stage cancers. The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor, the size of the patient's breast, certain features of the mammogram, and how the patient feels about preserving her breast. With either approach, lymph nodes under the arm generally are removed. Some patients with stage I and most with stage II breast cancer have chemotherapy and/or hormonal therapy. This added treatment is called adjuvant therapy, and is given to prevent the cancer from recurring (LaTour 131). Stage III is known as locally advanced cancer. The tumor in this situation measures more than two inches in diameter and has invaded other tissues near the breast (131). Patients with stage III breast cancer usually have both local treatment to destroy the tumor and systemic treatment to keep the cancer from spreading further. Systemic treatment can consist of chemotherapy, hormonal therapy, or both. Stage IV is called metastatic cancer, which implies the cancer has spread to other organs in the body (ACS Breast). Patients who have stage IV breast cancer receive chemotherapy and hormonal therapy to shrink the tumor, and radiation to control the spread of the cancer throughout the body. Clinical trials are also underway to determine if bone marrow transplants are effective in treating stage IV patients. Contrary to the negative press commonly attributed to breast cancer, there are viable treatment options for those diagnosed with this terrible affliction. The push for increased research in breast cancer is even coming from the White House. President Bill Clinton mentioned his support for increased funding for research and prevention in his recent State of the Union Address, and he urged insurance companies to pay for more mammograms. Hopefully, with the support from the White House, new treatments can be found for breast cancer, and maybe with a little luck we will have a cure by the turn of the century. Works Cited American Cancer Society. Breast Cancer. Document 004070. American Cancer Society. For Women Facing Breast Cancer. 1995. Kushner, Rose. If You've Thought About Breast Cancer. Kensington, MD: Rose Kushner Breast Cancer Advisory Center, 1994. LaTour, Kathy. The Breast Cancer Companion. New York: William Morrow and Company, Inc., 1993. National Institutes of Health. National Cancer Institute. What You Need to Know About Breast Cancer. Revised August 1995. f:\12000 essays\health & humanities (196)\Bursitis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ j Bursitis Does it hurt to move your arm? Is it tender and radiating pain to your neck and finger tips? Do you have a fever? If you answered yes to two or more of these questions then you may have typical joint injury called bursitis. Bursitis is an inflammation of the bursa that is easily prevented, detected and treated. Bursitis is a common condition that can cause much pain and swelling around an affected bursa. A bursa is a sac between body tissues that move against each other. They are filled with a lubricating liquid to minimize the fiction between the tissues. The bursa are found mostly in joints between skin and bone or bone and tendons. When you irritate these lubricating sacs, the bursae fill with fluid and become irritated and inflamed. This inflammation causes severe pain with movement of the joint, often limiting the movement of the affected area. Bursitis commonly strikes in the shoulders, elbows, knees, pelvis, hips or Achilles tendons. Bursitis can affect nearly anyone for any number of reasons. It affects mainly adults both male and female. The individuals most at risk are people who engage in excessive and improper stretching and people who are involved heavily in athletic training. Bursitis can be caused by many things. For one, it can be caused by injury or overuse of a joint. Strenuous unfamiliar exercise also can cause Bursitis. Plus, such diseases as gout, arthritis, and chronic infection of a joint can be likely causes. But frequently the cause of Bursitis can not be determined. The only ways to prevent getting it are to wear protective gear when exorcising, practice appropriate warm ups and cool downs during exercise and to maintain a high fitness level. Bursitis is an easily treatable disease. If you suspect that you have bursitis, you will probably seek the advice of a doctor. Most likely the doctor will look at your medical history and take some x-rays. If you are diagnosed with bursitis the doctor may prescribe some non-steroidal anti-inflammatory drugs and/or pain relievers and may make some cortisone injections into the bursa to relieve inflammation. Once at home you are expected rest the affected area as much as possible and to apply RICE ( rest, ice, compression and elevation of the inflamed joint). Also to prevent the joint from freezing you should begin moving and exercising the affected area as soon as possible. Most likely the problem will subside in 7 to 10 days if proper care is taken. Bursitis a common, yet painful, joint disorder that can be diagnosed and treated with much ease. Although it is most common in athletes, it can happen to anyone. So take the proper precautions to prevent yourself from acquiring this painful inflammation of the joints known as Bursitis. Bibliography 1. Jeffrey R.M. Kunz MD, Asher J. Finkel MD, eds. The American Medical Association: Family Medical Guide. New York: Random House, 1982. 2. Griffth, H. Winter. Bursitis. Putnam Berkel Group, 1996. Online. Lycos. Internet. 19 November 1996. 3. Lockshin, Micheal. "Bursitis." World Book. 1992 ed. f:\12000 essays\health & humanities (196)\Business Etiquette.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Business Etiquette As your career progresses, you develop skills which are respected and expected, professional etiquette. Professional etiquette builds leadership, quality, business, and careers. It refines skills needed for exceptional service. Whether you are an executive or just starting out, a seminar in Professional business etiquette, nationally and internationally will definitely be beneficial to you. Without proper business etiquette, you limit your potential, risk you image, jeopardize relationships that are fundamental to business success. Etiquette, formerly perceived as soft skills, business professionals have found that etiquette influences their success because it differentiates them in a competitive market. Honors commitments to quality and excellence. Etiquette enables them to be confident in a variety of people from many cultures. Etiquette also modifies distracting and unacceptable behavior and develops admired conduct (Klinkenburg.) Why should we be concerned about etiquette issues in the business arenas of the 90s? Basically because diversity, based on gender, cultural background, age, and degree of experience in today's business, creates a clash of standards and behavioral expectation. Not only is these differences internationally a concern, but also a concern among the relationships of Americans. Finally globalization has changed the way we do business, demanding new levels of expertise in dealing with people (Klinkenburg.) Rude business etiquette goes on daily in our country. Sometimes it is so common, people start to perceive it as normal behavior of our society. As stated before, proper business etiquette will get you farther, just that extra step will lead you to better business and better relationships. One of the most observed behaviors in United States is telephone rudeness. For instance, not returning telephone calls, taking calls in meetings, and not identifying yourself on the phone. The standard rule in business is to return routine phone calls within 24 hours and to apologize if the call is later. Return phone calls, fax, write a note or have your staff call, but do get back to people. It is an expected professional gesture to identify yourself when you place a call. Say your name, the company or business you represent to take people off the spot. Then state the nature of you call. If you do not identify yourself, expect to be asked and do not take offense. When answering telephone calls, your expected to make a connection promptly when a call comes in. This is more than a form of courtesy; prompt telephone service suggests to callers an efficient company. The appropriate telephone greeting conforms with the time of day and then the policy of the company - for example, "Good afternoon, The Smith Company," or , "Good afternoon, Procter and Gamble." Knowing that he/she has the right number, the caller merely has to ask for the individual he/she is calling. Anyone who has a visitor in his office should avoid making calls, unless they are pertinent to the business being discussed. As for incoming calls, when the individual who is you guest is very important, or the subject of your discussion is involved, tell your secretary not to put through any but the utmost urgent calls that come in for hem/her even when he/she has a guest, because the alternative is a long list of calls to be made afterwards. If call do come in, excuse yourself to your guest and make the telephone conversation as brief as possible. Do not continue your conversation with your guest as you pick up the receiver; finish what you are say first and then pick it up (Parker .) Interruptions are another complaint that is commonly observed as rude business etiquette. These rude interruptions are of conversations, of work, and by telephone. Let people finish their sentences and their thoughts. Never presume to know what they will say or how they should say it. Develop the judgment to detemining whether to rush a person in expressing themselves or allow them time to talk (Hilkenburg ) you can interrupt people if they begin to ramble, discuss unrelated work incidents, or keep you from performing your necessary work. If someone else interrupts anther in your presents, interrupt them to say, "Now, wait a minute, I want John to finish his thought." Always remember people and their opinions deserve respectful consideration (Hilkenburg.) Inappropriate business appearance is also neglected in our society often people disregard the importance of appearance, but it does influence peoples perceptions of you. Excessive hairstyles, makeup, jewelry, and fragrance detract from the professional image, as do worn, spotted, or ill-fitting clothing. Dress not to distract, but to accomplish your professional goals. Yet clothing and visual image is a backdrop, not a feature, for your professionalism. Your professional appearance matters. To some, this may be the most obvious thing in the world. But you would be surprised how many people arrive for job interviews or client meetings dressed like a bike messenger ( Richardson 190.) Certain dress is accepted in different organizations and in different part of United States. There are 3 rules about your professional appearance that remain consistent: 1. If you want the job, you have to look the part 2. If you want the promotion, you have to look promotable 3. If you want to be respected, you have ????? you may have heart the saying, "If you want to move up, dress like the person two levels ahead of you. You are going to command more respect if you dress professionally and are well groomed. if you dreamlike a slouch, you will be treated that way (Richardson 191.) many offices are moving toward casual Fridays. Casual dress generally means "nice" casual. Be comfortable, but remember you are still at work and are representing yourself and the organization. Appearance and norms vary among industries and around the country. It is the work that shows how creative you are, not how you dress. Dress to honor the position you occupy, if not yourself (Richardson 191.) Lack of appreciation is also over looked in professional etiquette. Take time to show your appreciation towards clients, colleagues and supervisors. It could be in the form of a thank-you note for a nice evening, conduct above and beyond, favors, or support. Included in neglected appreciation is ignoring RSVP's. Other surrounding RSVP's are lackluster acceptance, "I am not sure if I can come or not," or "I will if I can." Always remember to show your appreciation to others, no matter how small. Remember the Golden Rule, "Do unto others as they would have you do unto them." Being consistently late and not honoring peoples time is also considered unprofessional etiquette. Most everyone forgive occasional lateness with a reasonable explanation, but everyone tires of the person who is consistently late for appointments, who starts meetings 15 minutes late, who exceeds deadlines for reports or deliveries, and who gives short notice for work to be done or meeting to attend. In the American culture, time is considered a commodity, if you are neglecting the clients time, you are neglecting their finances (Hilkenburg.) Time really is money and organizations spend it in different ways. Some expect you to account for every moment. Advertising agencies, law firms, and some other types of business bill clients at an hourly rate for you time. Others may allow you to come and go as you please, as long as the job is completed. Introductions are a common and important event in every business setting. Knowing a few basic facts about introductions will help you master the art of introducing people correctly. Many introductions usually involve people who are meeting for a reason, or whose meeting has some business connection. Sometimes it is helpful, if not essential, to add a few words of explanation to your introductions, so each person is made aware of the business connection with the other. It is more important to be cordial in making introductions, and to get names and titles correct, than it is to absolutely correct in the introduction procedure. A natural and simple introduction that may slightly violate the rules is better than a awkward effort to be proper. Who is to be introduced to whom? In introducing a man to a women, the basic rule is that a man is presented to a women, even if she is younger than he is. In business, other exceptions are sometimes made when other elements of rank or status are a strong factor. For example, when a make executive is meeting hes new female assistant, his authority is so direct, and basic that it is logical to introduce her to him. But it would also be correct to follow the basic rules and present him to her. Present younger persons to older ones. If other factors are equal, including sex, you would most likely present a younger person to his or her senior in age. However, where two women are concerned, it is more tactful not to draw attention to the fact that one is older, unless the age is a considerable one. Present a person of lower rank to his/her superior. If two people are of the same sex, and not widely rated by age, introduce the person of lower rank to his supervisor. The basic forms of introductions: here are acceptable ways of introducing one person to another: (most formal) Mrs. Smith, may a I present Mr. Crane? (less formal) Mrs. Smith, may I introduce Mr. Crane? (informal) Ann Smith, I would like you to meet Bill Crane. The first two examples often are pronounced as statements, not as questions. If you would like to make less distinction in who is being presented to who use forms as "this is" or just the pronouncing of names. If it should happen that you mention first the name of the person of lesser importance do not become flustered, simply alter the wording: "Mr. Crane I would like to introduce you to Ms. Smith." If you have reason to believe that two men (or two women) might already have met, you may choose to use this introduction: "Jack Smith, have you met Jim Brown?" However, it is considered improper to ask a women whether she has met a man; you would not say "Miss Smith have you met Mr. Jones?" Introductions by first name only are not acceptable. It is considered poor form to use these phrases of introduction: 1. "meet" (used alone as, "Mr. A meet Mr. B.") 2. "meet up with" 3. "shake hands with" 4. I would like to make you acquainted with." If you have to introduce someone to a fairly large group, handle the introduction in the simplest and most comfortable way you can. If the person you are introducing will have a close connection with the people in the group, you should go through a complete introduction. In introducing someone to the entire group, avoid running through all the names without a break. It is better to introduce two or three people at a time, so the names can register and acknowledgments can be made. It is not necessary in a large group to introduce all the women before the men. It may even be advisable to simply present the person, by name to the group, with explanation that they will have a chance to meet properly later. This method would not be polite unless there were a reason why making introductions would be impractical at the time. There are numerous occasions in business when you will have to introduce yourself. For example, should you come out of you office to meet someone who has been waiting to see you, you might say, "Mr. Smith, I am Mr. Jones. Please come in." In most business situations men frequently introduce themselves to other men by using their last name with not title, (Smith, instead of Mr. Smith) but to a women in business a man would always use his title, even on the phone: "Miss Brown, this is Mr. Smith of XYZ company." When you are being introduced to someone, give him/her you full attention. When the introduction is completed, you should acknowledge it verbally, and perhaps also by shaking hands. Proper response to introductions that are acceptable; How do you do?, It is nice to meet you, I am so glad to meet you, I am glad to make you acquaintance, or pleased to meet you. A man stands to be introduced to a women or a man, a women is expected to stand for introductions to men or women considerably older than herself, or meeting people of important status. it is generally accepted that an executive level would not have to stand to greet a male or female applicant (although he could.) A man always shakes hands with another man to whom he is introduced. A very young man meeting a much older man might wait for the older man to extend his hand first, as a sigh of deference. Women in business may or may not shake hands with each other; if one offers her hand, the other should respond in kind and without hesitation. In social situations a man is not expected to offer his hand to a women unless she first offers hers, but in business it is not unlikely for a man to offer his hand to a women he is meeting. Naturally, she would return the handshake. If the man does not initiate the handshake she may offer her hand or not a she wishes. Always remember that proper introduction and responses to introductions are very important, since they are a factor in establishing good first impressions. Sending gifts to clients and customers, particularly at Christmas time - is a traditional practice with a large number of business people. Most do it because they enjoy giving gifts and look on the custom as a form of public relations. There are numerous occasions when a business man/women feels the obligation to send a gift. He/She may want to express his or her thanks, wish an associate good luck, or the celebration of a business anniversary. Flowers, plants, candy, and books are all way of saying "thank you" or "good luck." They are all gifts that do not make people feel obligated and that can be accepted without embarrassment. Business card are carried by all business people who call on other companies, clients, or customers. Never order business cards unless you are given permission to do so. The proper size of a business card is usually 3 1/2 x 2 inches. However, many companies use cards of a different size or shape, so their card will be distinctive. In the executive level, a business card usually has the persons name in the middle of the card and his/her title and the firm name in the lower right hand corner. Some very prominent men and women omit their title from the card and simply their name and name of company are present. Initials and abbreviations, while not correct on social calling cards, may be used on business cards, the title "Mr." does not precede the name. The business cards used by salesmen, or to advertise a company, frequently carry a trademark or emblem. The printing or engraving may be partly in color. The telephone number is always on a card of this type. Business cards should not be used for enclosure with a gift, even though the gift is going to a client or customer. The giving of a gift is a social gesture, and therefore a social card should be enclosed. however. presidents or board of chairmen of a large company often have a special card printed for enclosures of gifts. It mentions the company name and the name of the executive sending the gift, but does not resemble a business card. Out generation in the United States, is becoming to be known as the "Mcmanners Generation." Eating in fast food establishments has led to sloppy table manner and dining skills that can offend and cost clients. Ten Table Matters that Matter: 1. Spoons and knives are on the right, forks are on the left. Use them from the outside in. Solids like a bread plate or a salad are on the left, liquids like water, wine, or soda are on the right. 2. Napkins belong unfolded on your lap. Use the napkin to blot your mouth. Napkins stay off the table until the meal has ended. If you must excuse yourself, leave the napkin on you chair. 3. Pass serving dishes to the right to avoid table traffic jams. Make sure handles and serving utensils are facing the receiver. 4. Spoon soup away from you, and do not crumble crackers into it. 5. Keep your knife and fork on the plate if you are taking a break. 6. Keep your mouth closed when chewing. 7. Do not be the first person to take your jacket off during a meal. 8. Keep your elbows at your sides and off the table. 9. Push your chair in when leaving the table. 10. Make the effort to introduce yourself to everybody with talking distance of you at the table, and to direct questions to them to help get them involved with any conversation. Cocktail parties are a whole different affair than the seated meal. By learning a few simple rules and by practicing some easy maneuvering, you too, can handle canapés and cocktails with grace and make impressive first impressions. Never ever drink on a empty stomach; stop on the way to the event to grab a snack if necessary. The risks of losing control or being indiscreet are too great. In fact, be sure to pace your alcoholic intake throughout the course of the evening so you will not reveal your company's secrets, or tell a client's spouse what you really think of her or him. At the bar or food station get what you want and move away. Do not hold court directly in front of the bar; let others have access to the bar as well. But how can you move away from the bar and be able to juggle your food and drink? First of all, the right hand should always be kept free to shake hands with any man or women. Food, drink, napkin, - everything goes in the left hand. If you practice this technique you will never look like amateur juggler. Here is the most simplest way to juggle hor d'oeuvres and drinks: Take the cocktail napkin and put it between the ring and small finger of the left hand. Then, spread the ring and middle fingers to act as a base for the plate of hors d'oeuvres. Use the thumb and index finger to hold stem or base of the glass and to stabilize the top of the plate at the same time. As you need something reach for it with your right hand, use it and return in to the left hand.. A cold drink should never be held longer than the time it takes to have a sip. Do not fill your plate to overflowing. People seldom notice you going back for seconds at large parties, they will notice the mountain size heap on your plate. Dinner and parties are a major part of the business world, knowing the basic table manners and party etiquette will assist you in making wonderful impressions on clients, employers and others. First impressions are made, for the most part, within 5 seconds of meeting someone, so remember do not speak when you have a mouth full of broiled shrimp and cocktail sauce, and do not act like you are a football player at pre-game meal and load your plate! f:\12000 essays\health & humanities (196)\Can We Stop Teens from Smoking .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Stopping teens from smoking is a big challenge many communities face today. Many communities can only watch without action while local businesses continue to sell tobacco products to minors, even under risk of penalty of law. Recent studies show that a large percentage of teens today are getting their cigarettes from stores, mostly gas stations or convenience store. As teens continue to be able to buy their own cigarettes, more and more communities begin to impose stronger punishments on merchants who sell to the teens. One community has experienced success in their attempts to stop the sale of tobacco products to minors. Woodridge, Illinois, started a program seven years ago which forbade and strictly punished the sale of tobacco products to minors. The entire program includes local licensing of vendors, repeated undercover inspections to see if the sale to minors has stopped, and education programs in schools. Woodridge has become a model community as other communities are moving to stop teen tobacco use. A recent national study showed that 36.5% of females, and 40.8% of males buy their cigarettes from stores, whether it be a gas station or a supermarket. Hopefully, as more and more merchants see the trouble they face if caught selling to minors, they will stop selling. True, tightening down on stores that sell tobacco to minors isn¹t going to completely stop the problem of teen tobacco use. Teens continue to get them from other sources. But it definitely does hamper their efforts. With more education in schools, and perhaps stronger punishments for teens caught with tobacco, more and more teens will see the problems with the tobacco usage, and will stop the habit. f:\12000 essays\health & humanities (196)\Cancer.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ INTRODUCTION In the American society, cancer is the disease most feared by the majority of people within the U.S. Cancer has been known and described throughout history. In the early 1990s nearly 6 million cancer cases and more than 4 million deaths have been reported worldwide, every year. The most fatal cancer in the world is lung cancer, which has grown drastically since the spread of cigarette smoking in growing countries. Stomach cancer is the second leading form of cancer in men, after lung cancer. Another on the increase, for women, is breast cancer, particularly in China and Japan. The fourth on the list is colon and rectum cancer, which occurs mostly in older people. In the United States more than one-fifth of the deaths in the early '90s was caused by cancer, only the cardiovascular diseases accounted at a higher percentage. In 1993 the American Cancer Society predicted that about 33% of Americans will eventually get cancer. In the United States skin cancer is the most dominating in both men and women, followed by prostate cancer in men and breast cancer in women. Yet lung cancer causes the most deaths in men and women. Leukemia, or cancer of the blood, is the most common type in children. An increasing incidence has been clearly observable over the past few decades, due in part to improved cancer screening programs, and also to the increasing number of older persons in the population, and also to the large number of tabacco smokers--particularly in women. Some researchers have estimated that if Americans stopped smoking, lung cancer deaths could virtually be eliminated within 20 years. The U.S. government and private organizations spent about $1.2 billion annual for cancer research. With the development of new drugs and treatments, the number of deaths among cancer patients under 30 years of age is decreasing, even though the number of deaths from cancer is growing overall. TYPES OF CANCER 1.Cancer is the common term used to designate the mosst aggressive and usually fatal forms of a larger class of the diseases known as neoplasms. A neoplasm is described as being relatively autonomous because it does not fully obey the biological mechanisms that govern the growth and the metabolism of individual cells and the overall cell interactions of the living organism. Some neoplasms grow more rapidly than the tissues from which they arise, others grow at a normal pace but because of the other factors eventually become recognizable as an abnormal growth and not normal tissue. The changes seen in neoplasm are heritable in that these characteristics are passed on from each cell to ots offspring, or daughter cells. Neoplasm occurs only in muticellular organisms. The main classification of the neoplasms as either benign or malignant relates to their behavior. Several relative differences classify these two classes. A benign neoplasm, for instance, is harmless, but malignant is not. Malignancies grow more rapidly than do benign forms and invade adjacent normal tissues. Tissue of a benign tumor is structured in a manner similar to that of the tissue from which it is derived, malignant tissue, however, has an abnormal and unstructured appearance. Most malignant tumors, in fact, exhibit abnormalities in chromosome structure, that is, the structure of the DNA molecules that constitute the genetic materials duplicated and passed on to later generations of cells. Most important, however, benign neoplasms do not begin to grow at sites other than the point of origin, whereas malignant tumors do. The term TUMOR is used to indicate a readily defined mass of tissue that is recognizable from normal living tissue. Thus a scar, an abcess , and a healing bone callus are all designated as tumors, but they are not neoplasms. Besides being classified according to their behavior, neoplasms can also be classified according to the tissue from which they arose, and they are usually designated by a tissue-type prefix. A general system of tnonmenclature has als arisen to distinguish benign and malignant neoplasms. The designation of the benign neoplasm usually is signified by the suffix-oma added to the appropriate tissue type prefix. Malignant neoplasms are separated into two general classes. Cancers arising from such supportive tissues as muscle, bone and fat are termed sarcomas. Cancers arising from such epithelial tissues as the skin and lining the mouth, stomach, bowel, or bladder are classified as carcinomas. Examples of benign neoplasms are a lipoma (from fat tissue) and an osteoma (from bone). Malignant counterparts of these neoplasms are a liposrcoma and an osteosarcoma. The term adenoma is used to indicate a benign neoplasm of glandular tissue, and corresponding malignancies are termed adenocarcinomas. Exceptions to this form of nomenclature include thymomas, which are either malignant or bengnneoplasms of the thymus gland, and such descriptive terms os dermoid, a benign tumor of the ovary. The suffix-blatoma denotes a primitive, usually malignant, neoplasm. Leukemia, literally meaning "white blood," is the term used to designate malignant neoplasms having a major portion of their cells circulating in the blood stream. Most leukemia's arise in the blood-forming tissues, such as the bone and in the lymphatic tissues of the body. CAUSES OF CANCER 2.A cancer-causing agent-- chemical, biological, or physical--is termed a carcinogen. Substances are labeled carcinogens if, when administered to a population of previously untreated organisms, thet cause a statistically significant increase in the incidence of the neoplasms compared with the incidence in subjects that are left untreated. FOOTNOTES 1.) ACADEMIC AMERICAN ENCYCLOPEDIA (pp. 5-10) 2.)AMERICAN CANCER SOCIETY'S COMPLETE BOOK OF CANCER (25-27) BIBLIOGRAPHY AMERICAN CANCER SOCIETY'S COMPLETE BOOK OF CANCER, GROLIER ELECTRONIC PUBLISHING COMPANY ANDERSON, PAUL, ADVANCES IN CANCER CONTROL, GROLIER ELECTRONIC PUBLISHING COMPANY LASZLO, JOHN, UNDERSTANDING CANCER, GROLIER ELECTRONNIC PUBLISHING COMPANY f:\12000 essays\health & humanities (196)\cardiovascular disease and exercise.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Analysis of the Free-Throw Shot When deciding about a movement to study, I thought about many, and very few interested me. Then I decided to choose something that was very important to me. Shooting the basketball, and more specifically the technique in performing a free throw. I thought by looking more closely at the details of a movement I have been doing since a small child. I thought possibly I could learn something that would give me an advantage in my shot. The application of this particular movement is for shooting a free-throw, which is a stand still uncontested shot. There are a few rules that go with shooting a free-throw, such as you have to be behind the fifteen foot line, called the free-throw line, and you can't cross that until after the ball makes contact with the rim. When performing this skill you should also be aware of the other factors that could influence your accuracy in performing the free-throw. The rim is fifteen feet from the free-throw line on center. Also you should be aware of the fact you can fit three basketballs through the rim at the same time if placed together. Also the rim is ten feet high from the floor, meaning you have to make sure win shooting the ball, that the angle is higher than ten feet at its peak so then on its decent to the basket it will have a chance to go in. If you don't get it higher than ten feet it has no chance to go in. When you start talking all these angle's and trajectories, you can begin to understand why some people are accurate and some are not. Shooting free-throws is not a thing of chance or luck. It is something that takes repetition. To be a good free-throw shooter you need to have a repetitive action, not something that changes every time. Since the conditions are predictable it is very easy to become a good repetitive free-throw shooter. If you would be unsure about the correct movements, it would be beneficial to study the movements of someone who is one of the best at what you were studying. The best of our time would be Mark Price of the NBA. He has a career free-throw average over ninety percent, which by free-throw standards is very good. To give you an idea of how well that is, you need to examine the averages. If a person was to shoot over seventy percent for the year, they would be considered a decent free-throw shooter. Someone over eighty percent is considered good. So if you are able to shoot ninety percent over a career spanning more than ten years, you are considered one of the best ever. Everyone has there own personal technique or procedure leading up to the actual shot. Probably the most common routines would be to stay off the free-throw lime until referee is ready for you, and then step up to the line and receive the ball. Once you step to the line and receive the ball you want to get in a comfortable position with your feet shoulder width apart, and your dominant side foot slightly in front of your other. Balance is key to shooting because you want to end your shot on the balls of your feet, and if you are not balanced you will fall forward and the shot will not count. Then you want to take a deep breath and relax. Some people will bounce ball one time or five the ten, it is all personalized. Then you want to focus on rim, bend at the knees and deliver the ball. This would be the sequence that is most commonly followed. By following the same sequence every time you begin to develop a rhythm and that is what you want. You need to find what is comfortable and stick with it. Along with this sequence of events leading to the shot, you want to be aware of proper shooting technique. Proper shooting technique would be to rest the ball on the fingertips of your hand. You do not want the ball resting in your palm. Control of the shot comes from the fingers. You want to use your non dominant hand as support on the side to the ball. This hand has nothing to do with the shot, it is there only for support of the ball. Then you would want to bring the ball up to the forehead creating a window between your arms. This is where you want to focus on the rim and extend at the elbow, and extending at the wrist. Now to talk about what all this really means and how you get the ball from your hand to the rim. When we do it, we consider it to be very simple, but it is actually a very complex movement, involving many different muscles. Many muscles are involved, some more than others. I will first talk about the ones used the least. The shoulder girdle involves muscles that are key to the movement, but are mostly used in stabilization of the shoulder. The Trapezius and the Rhomboid muscles are stabilizers of the shoulder along with the rotator cuff muscles including the Supraspinatis, Infraspinatis, Teres Minor, and Subscapularis which provide dynamic stability of the shoulder. All these muscles are key, but are not involved much in the actual movement. The Serratus Anterior is commonly used in movements drawing the scapula forward with slight upward rotation, and would be used in shooting the basketball and works in conjunction with Pectoralis Minor. Now we will get into some of the muscles actually doing the work when shooting the free-throw. The Deltoid, which is one of the most important muscles involved in any shoulder movement is responsible for the movement of the Humerus. Any movement of the Humerus will involve the Deltoid. The Coracobrachialis assist in flexion of the shoulder. Other muscles involved in the cocking phase of the shot are the Biceps Brachii, Brachialis, and Brachioradialis which are all strong flexor's of the elbow. The Pronator Teres would be used to place hand in pronated position so you could balance ball when you are attempting the shot. While the ball is resting in the hand, the wrist will be extended by the Extensor Carpi Ulnaris, Extensor Carpi Radialis Brevis, Extensor Carpi Radialis Longus. The two radialis muscles are important in any activity requiring wrist extension or stabilization of the wrist against resistance, particularly when the forearm is pronated. A few other muscles involved in weak wrist extension are the Extensor Digitorum, Extensor Indicis, Extensor Digiti Minimi, Extensor Pollicis Longus and Brevis. Now for the part of the shot, that is the most crucial ingredient of all, the release. The Triceps Brachii which are used in hand balancing and any pushing movement involving the upper extremity. Triceps Brachii and the Anconeus are the two elbow extensors. The chief function of the Anconeus is to pull the synovial membrane out of the way of the olecranon process during extension of the elbow. Now to move a little further down the arm, we get into the wrist flexors. The Flexor Carpi Radialis and Ulnaris along with the Palmaris Longus are the most powerful. The Flexor Digitorum Superficialis insert into each of the four fingers, and along with the Flexor Digitorum Profundus are the only muscles involved in all four finger flexion. Along with these the Flexor pollicis Longus provides some assistance in wrist flexion. Flexion of the elbow and the wrist is where you generate the force to get the ball to the rim, so I would consider the flexors most important, although all play a significant role. To become very proficient and increase your accuracy I would recommend strengthening the flexors, or the muscles involved in the release. To strengthen these muscles you would increase your chances of accuracy while fatigued, when free-throws are crucial in winning or loosing. To strengthen the Triceps Brachii and Anconeus, you would do push ups or dips. For the Flexor Carpi Radialis and Ulnaris along with the Palmaris Longus, I would recommend wrist curls in the supinated position. Then the last group I could say to squeeze a tennis ball or any other gripping exercise for the Flexor Digitorum Superficialis, Flexor Digitorum Profundus, and the Flexor Pollicis Longus. Through all of this I have discovered how complex movements really are, and that as an athlete I need to be aware of the things I can do to increase my performance, and through this I was able to narrow down what muscles to concentrate on to improve my performance. References Dayton, William. Sports Fitness and Training. Pantheon Books: New York, 1987. McArdle, William D. Exercise Physiology. Lea & Febiger: Philadelphia, 1981. Wirhed, Rolf. Athletic Ability, The Anatomy of Winning. Harmony Books: New York, 1984. Analysis of the Free-Throw Shot by Shane Stocks Kinesiology Paul Bruning April 07, 1997 f:\12000 essays\health & humanities (196)\Chicken Pox vs Tubercolosis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ CHICKEN POX OR VARICELLA VS. TUBERCULOSIS OR TUBERCLE BACILLI HISTORY OF CHICKEN POX Chicken pox, a highly contagious disease that strikes many people, is caused by the herpes zoster virus. The virus is transmitted by the respiratory system and carried in the bloodstream to all parts of the body. The main symptom is a rash that appears on the face and torso, but also on the extremities. The rash turns into blisters that itch like crazy ( I know from personal experience), that go away in a few days. The other symptoms are loss of appetite, fever, and headache. HISTORY OF TUBERCULOSIS An acute infectious disease of humans and some animals, tuberculosis is caused by bacteria of the genus Mycobacterium. One of the oldest known diseases, it was known as the great white plague. TB was one of the leading causes of deaths in adults until an antituberculosis drug was introduced in the 1940's. The disease can remain dormant for years before becoming active. The typical symptoms are fatigue, night sweats and fever, loss of appetite and weight, and a constant cough. Hemorrhages may occur due to the destruction of lung tissue. The disease is spread through extended exposure to an infected person, because when the victim coughs infected droplets into the air, they can be inhaled by someone near by. f:\12000 essays\health & humanities (196)\Chrones Disease.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Inflammatory bowel disease (IBD) is a group of chronic disorders that cause inflammation or ulceration in the small and large intestines. Most often IBD is classified as ulcerative colitis or Crohn's disease but may be referred to as colitis, enteritis, ileitis, and proctitis. Ulcerative colitis causes ulceration and inflammation of the inner lining of a couple of really bad places, while Crohn's disease is an inflammation that extends into the deeper layers of the intestinal wall. Ulcerative colitis and Crohn's disease cause similar symptoms that often resemble other conditions such as irritable bowel syndrome (spastic colitis). The correct diagnosis may take some time. Crohn's disease usually involves the small intestine, most often the lower part (the ileum). In some cases, both the small and large intestine (those really bad places again) are affected. In other cases, only the SUPER really bad place is involved. Sometimes, inflammation also may affect the mouth, esophagus, stomach, duodenum, appendix, or some nasty sounding word. Crohn's disease is a chronic condition and may recur at various times over a lifetime. Some people have long periods of remission, sometimes for years, when they are free of symptoms. There is no way to predict when a remission may occur or when symptoms will return. The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. There also may be rectal bleeding, weight loss, and fever. Bleeding may be serious and persistent, leading to anemia (low red blood cell count). Children may suffer delayed development and stunted growth. What Causes Crohn's Disease and Who Gets It? There are many theories about what causes Crohn's disease, but none has been proven. One theory is that some agent, perhaps a virus, affects the body's immune system to trigger an inflammatory reaction in the intestinal wall. Although there is a lot of evidence that patients with this disease have abnormalities of the immune system, doctors do not know whether the immune problems are a cause or a result of the disease. Doctors believe, however, that there is little proof that Crohn's disease is caused by emotional distress or by an unhappy childhood. Crohn's disease affects males and females equally and appears to run in some families. About 20 percent of people with Crohn's disease have a blood relative with some form of inflammatory bowel disease, most often a brother or sister and sometimes a parent or child. How Does Crohn's Disease Affect Children? Women with Crohn's disease who are considering having children can be comforted to know that the vast majority of such pregnancies will result in normal children. Research has shown that the course of pregnancy and delivery is usually not impaired in women with Crohn's disease. Even so, it is a good idea for women with Crohn's disease to discuss the matter with their doctors before pregnancy. Children who do get the disease are sometimes more severely affected than adults, with slowed growth and delayed sexual development in some cases. How Is Crohn's Disease Diagnosed? If you have experienced chronic abdominal pain, diarrhea, fever, weight loss, and anemia, the doctor will examine you for signs of Crohn's disease. The doctor will take a history and give you a thorough physical exam. This exam will include blood tests to find out if you are anemic as a result of blood loss, or if there is an increased number of white blood cells, suggesting an inflammatory process in your body.The doctor may look inside your body through a flexible tube, called an endoscope, that is inserted somewhere really bad! During the exam, the doctor may take a sample of tissue from the lining of the really bad place to look at it under the microscope. Later, you also may receive x-ray examinations of the digestive tract to determine the nature and extent of disease. These exams may include an upper gastrointestinal (GI) series, a small intestinal study, and a barium enema intestinal x-ray. These procedures are done by putting the barium, a chalky solution, into the upper or lower intestines. The barium shows up white on x-ray film, revealing inflammation or ulceration and other abnormalities in the intestine. If you have Crohn's disease, you may need medical care for a long time. Your doctor also will want to test you regularly to check on your condition. What Is the Treatment? Several drugs are helpful in controlling Crohn's disease, but at this time there is no cure. The usual goals of therapy are to correct nutritional deficiencies; to control inflammation; and to relieve abdominal pain, diarrhea, and bleeding in a really bad place. Abdominal cramps and diarrhea may be helped by drugs. The drug sulfasalazine often lessens the inflammation, especially in the colon. This drug can be used for as long as needed, and it can be used along with other drugs. Side effects such as nausea, vomiting, weight loss, heartburn, diarrhea, and headache occur in a small percentage of cases. Patients who do not do well on sulfasalazine often do very well on related drugs known as mesalamine or 5-ASA agents. More serious cases may require steroid drugs, antibiotics, or drugs that affect the body's immune system such as azathioprine or 6-mercaptopurine. Can Diet Control Crohn's Disease? No special diet has been proven effective for preventing or treating this disease. Some people find their symptoms are made worse by milk, alcohol, hot spices, or fiber. But there are no hard and fast rules for most people. Follow a good nutritious diet and try to avoid any foods that seem to make your symptoms worse. Large doses of vitamins are useless and may even cause harmful side effects. Your doctor may recommend nutritional supplements, especially for children with growth retardation. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may need periods of feeding by vein. This can help patients who temporarily need extra nutrition, those whose bowels need to rest, or those whose bowels cannot absorb enough nourishment from food taken by mouth. What Are the Complications of Crohn's Disease? The most common complication is the closing of the intestine. Blockage occurs because the disease tends to thicken the bowel wall with swelling scar tissue, narrowing the passage. Crohn's disease also may cause deep ulcer tracts that burrow all the way through the bowel wall into surrounding tissues, into adjacent segments of intestine, into other nearby organs such as the urinary bladder or into the skin. These tunnels are called fistulas. They are a common complication and often are associated with pockets of infection or abcesses or infected areas of pus. The areas around the really bad part and another really bad part having to do with the southern part of the body often are involved. Sometimes fistulas can be treated with medicine, but in many cases they must be treated surgically. Crohn's disease also can lead to complications that affect other parts of the body. These systemic complications include various forms of arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems respond to the same treatment as the bowel symptoms, but others must be treated separately. Is Surgery Often Necessary? Crohn's disease can be helped by surgery, but it cannot be cured by surgery. The inflammation tends to return in areas of the intestine next to the area that has been removed. Many Crohn's disease patients require surgery, either to relieve chronic symptoms of active disease that does not respond to medical therapy or to correct complications such as intestinal blockage, perforation, abscess, or bleeding. Drainage of abscesses or removal of a section of bowel due to blockage are common surgical procedures. Sometimes the diseased section of bowel is removed. In this operation, the bowel is cut above and below the diseased area and reconnected. Infrequently some people must have their really bad places removed. In an ileostomy, a small opening is made in the front of the abdominal wall, and the tip of the lower small intestine (ileum) is brought to the skin's surface. This opening, called a stoma, is about the size of a quarter or a 50-cent piece. It usually is located in the right lower corner of the abdomen in the area of the beltline. A bag is worn over the opening to collect waste, and the patient empties the bag periodically. The majority of patients go on to live normal, active lives with an ostomy. The fact that Crohn's disease often recurs after surgery makes it very important for the patient and doctor to consider carefully the benefits and risks of surgery compared with other treatments. Remember, most people with this disease continue to lead useful and productive lives. Between periods of disease activity, patients may feel quite well and be free of symptoms. Even though there may be long-term needs for medicine and even periods of hospitalization, most patients are able to hold productive jobs, marry, raise families, and function successfully at home and in society. Works Cited.. and a couple other suggested readings. Bleeding in the Digestive Tract and Ulcerative Colitis. National Digestive Diseases Information Clearinghouse, 2 Information Way, Bethesda, MD 20892-3570. General patient information fact sheets. Brandt, LJ, Steiner-Grossman, P, eds. Treating IBD: A Patient's Guide to the Medical and Surgical Management of Inflammatory Bowel Disease. New York: Raven Press, 1989. General guide for patients with sections on treatment and descriptions and drawings of surgical procedures. Available from the Crohn's & Colitis Foundation of America. Hanauer, SB, Peppercorn, MD, Present, DH. Current concepts, new therapies in IBD. Patient Care, 1992; 26(13): 79-102. General review article for health care professionals. Steiner-Grossman, P, Banks PA, Present, DH, eds. The New People Not Patients: A Source Book for Living with IBD. Dubuque, Iowa: Kendall/Hunt Publishing Company, 1992. Book for patients with sections on diagnostic tests, medications, nutrition, coping with employment and health insurance problems, and IBD in children and teenagers, older adults, and during pregnancy. Available from the Crohn's & Colitis Foundation of America. Additional Resources Crohn's & Colitis Foundation of America, Inc., 386 Park Avenue South, 17th Floor, New York, NY 10016-8804; (800) 932-2423 or (212) 685-3440. Pediatric Crohn's & Colitis Association, Inc., P.O. Box 188, Newton, MA 02168; (617) 244-6678. Reach Out for Youth with Ileitis and Colitis, Inc., 15 Chemung Place, Jericho, NY 11753; (516) 822-8010. United Ostomy Association, 36 Executive Park, Suite 120, Irvine, CA 92714; (800) 826-0826 or (714) 660-8624. National Digestive Diseases Information Clearinghouse 2 INFORMATION WAY BETHESDA, MD 20892-3570 "The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health, under the U.S. Public Health Service. The clearinghouse, authorized by Congress in 1980, provides information about digestive diseases to people with digestive diseases and their families, health care professionals, and the public. The NDDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and government agencies to coordinate resources about digestive diseases. " f:\12000 essays\health & humanities (196)\Cigarettes and Their Destruction of the Brain.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Cigarettes and Their Destruction of the Brain Smokers generally feel more comfortable after that especially important first cigarette of the day. Within just a few seconds of "lighting up," smoking activates mind-altering changes. Smokers are well aware of the long-term risks of their habit: such as lung cancer, heart disease, emphysema, and other deadly illnesses. However, smokers are attracted by the immediate effects of smoking: "a stimulant that makes them seem to feel more alert, clearheaded and able to focus on work." Smoking however, does not really have these effects; what the smoker perceives is an illusion. Nicotine begins to act on brain cells within ten seconds of inhalation, fitting into "keyholes" on the surface of the brain; the same "keyholes" as acetylcholine(an important neurotransmitter), and mimicking epinephrine and norepinephrine, giving the smoker a rush, or stimulation. Within 30 minutes, smokers feel their energy begin to decline, as the ingested nicotine is reduced. This process continues, as the smoker's attention becomes increasingly focused on cigarettes. Nicotine causes smokers' brain cells to grow more nicotinic receptors than normal; therefore, the brain may function normally despite the irregular amount of acetylcholine-like chemical acting upon it. The brain is reshaped: the smoker feels normal with nicotine in his system, and abnormal without it. A series of tests were conducted on nonsmokers, "active" smokers, and "deprived" smokers. The "active" smokers were given a cigarette before each test, while the "deprived" smokers were not allowed cigarettes before tests. The tests started simply, and then moved towards more complex problems. In the first test, subjects sat in front of a computer screen and pressed the space bar when a target letter, among 96, was recognized: smokers, deprived smokers, and nonsmokers, performed equally well. The next test involved scanning sequences of 20 identical letters and as one of the letters was transformed into a different one, responding with the space bar. Nonsmokers responded fastest, and active smokers were faster than those who were deprived from smoking. In the third test, subjects were required to memorize a sequence of letters or numbers, and to respond when they observed the sequence among flashed groupings on the screen. The purpose of this experiment was to test short-term memory: nonsmokers again ranked highest, however, deprived smokers defeated the active smokers. Subjects were required to read a passage and then answer questions about it in the fourth test. "Nonsmokers remembered 19 percent more of the most important information than active smokers, and deprived smokers bested their counterparts who had smoked a cigarette just before testing. Active smokers tended not only to have poorer memories but also had trouble differentiating important from trivial details." In the final experiment, a computer-generated driving simulator(much like a video game) was used to test the subjects, who were required to operate a steering wheel, gearshift, gas pedal and brake, and to navigate through twisting roads, and sudden appearances of cars and oil slicks. Deprived smokers had 67 percent more rear-end collisions than nonsmokers, while the smokers who had just had a cigarette performed even worse: they had 3.5 times the rear-end collisions as did nonsmokers. As testing progressed, and became more complex, nonsmokers outperformed smokers by wider margins. As a smoker, I must state that I am concerned as to the findings of this article. I have an exceptional memory, however, it is not quite as sharp as it once was. I have considered quitting smoking, yet I have not yet taken any actions toward doing so; however, I have cut down from the amount that I previously have smoked, and am still progressing in this manner. This article has definitely forced me to reconsider my habit, as I'm sure it would be beneficial. I would advise all smokers to read this article and then evaluate their personal smoking habits. Works Cited "How Cigarettes Cloud Your Brain." Ponte, Lowell. Reader's Digest. March 1995. f:\12000 essays\health & humanities (196)\Cloning.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Genetic engineering, altering the inherited characteristics of an organism in a predetermined way, by introducing into it a piece of the genetic material of another organism. Genetic engineering offers the hope of cures for many inherited diseases, once the problem of low efficiencies of effective transfer of genetic material is overcome. Another development has been the refinement of the technique called cloning, which produces large numbers of genetically identical individuals by transplanting whole cell nuclei. With other techniques scientists can isolate sections of DNA representing single genes, determine their nucleotide sequences, and reproduce them in the laboratory. This offers the possibility of creating entirely new genes with commercially or medically desirable properties. While the potential benefits of genetic engineering are considerable, so may be the potential dangers. For example, the introduction of cancer-causing genes into a common infectious organism, such as the influenza virus, could be hazardous. We have come to believe that all human beings are equal; but even more firmly, we are taught to believe each one of us is unique. Is that idea undercut by cloning? That is, if you can deliberately make any number of copies of an individual, is each one special? How special can clones feel, knowing they were replicated like smile buttons. "We aren't just our genes, we're a whole collection of our experiences," says Albert Jonsen. But the idea, he adds, raises a host of issues, "from the fantastic to the profound." When anesthesia was discovered in the 19th century, there was a speculation that it would rob humans of the transforming experience of suffering. When three decades ago, James Watson and Francis Crick unraveled the genetic code, popular discussion turned not to the new hope for vanquishing disease but to the specter of genetically engineered races of supermen and worker drones. Later, the arrival of organ transplants set people brooding about a world of clanking Frankensteins, welded together made from used parts. Already there are thousands of frozen embryos sitting in liquid nitrogen storage around the country. "Suppose somebody wanted to advertise cloned embryos by showing pictures of already born children like a product," says Prof. Ruth Macklin, of New York's Albert Einstein College of medicine, who specializes in human reproduction. Splitting an embryo mat seem a great technological leap, but in a world where embryos are already created in test tubes, it's a baby step. The current challenge in reproductive medicine is not to produce more embryos but to identify healthy ones and get them to grow in the womb. Using genetic tests, doctors can now screen embryonic cells for hereditary diseases. In the not to distant future, prenatal tests may also help predict such common problems as obesity, depression and heart disease. But don't expect scientists to start building new traits into babies anytime soon. The technological obstacles are formidable, and so are the cultural ones. Copies of humans are identical, but are the people the same? Probably not. For a century scientists have been trying to figure out which factors play the most important role in the development of a human personality. Is it nature or nurture, heredity or environment? The best information so far has come from the study of identical twins reared apart. Twins Jim Springer and Jim Lewis, separated at birth in 1939, were reunited 39 years later in a study of twins at the University of Minnesota. Both had married and divorced women named Linda, married second wives named Betty and named their oldest sons James Allan and James Alan. Both drove the same model of blue Chevrolet, enjoyed woodworking, vacationed on the same Florida beach, and both had dogs named Toy. f:\12000 essays\health & humanities (196)\Cognitive Dissonance Theory.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Cognitive Dissonance How do human beings make decisions? What triggers a person to take action at any given point? These are all questions that I will attempt to answer with my theoretical research into Leon Festinger's theory of cognitive dissonance, as well as many of the other related theories. We often do not realize the psychological events that take place in our everyday lives. It is important to take notice of theories, such as the balance theory, the congruency theory and the cognitive dissonance theory so that one's self-persuasion occurs knowingly. As psychologist and theorist gain a better understanding of Festinger's cognitive dissonance theory manipulation could occur more easily than it already does in today's society. Leon Festinger's cognitive dissonance theory is very closely related to many of the consistency theories. The first of the major consistency theories, the balance theory, was proposed by Fritz Heider (1946, 1958) and was later revised by Theodore Newcomb (1953) (Larson, 1995). Heider and Newcomb's theory was mostly looking at the interaction between two people (interpersonally) and the conflicts that arose between them. When two people have conflicting opinions or tension is felt between another person, it is more likely persuasion will occur. Because if no tension was felt between the two parties, or there were no conflicting opinions there would be no need to persuade each other. If you think about it persuasion occurs only because there is tension between two facts, ideas or people. Charles Larson writes in his book, Persuasion, Reception and Responsibility, "another approach to the consistency theory is congruency theory, by Charles Osgood and Percy Tennenbaum (1955)" (p.82). This theory suggest that we want to have balance in our lives and there is a systematic way to numerically figure it out. When two attitudes collide we must strive to strike a balance between the two attitudes. The balance varies depending on the intensity we feel about each attitude and our pre-disposed positions concerning the attitude. We either have a favorable , neutral or unfavorable opinion concerning ideas. When two attitudes collide we will attempt to downgrade the favorable position and upgrade the unfavorable position so that we feel a balance. For example, suppose someone thought of Mel Gibson as a good role model. Later on they come to find out Mel Gibson does not like football. If the person was to like both football and Mel Gibson one of three things would happen: 1) The individual would downgrade their opinion of Mel Gibson, or 2) downgrade football, or 3) downgrade both. The action taken would create psychological consistency in one's mind. These theories are very interesting and have been quite researched, but none more so than Leon Festinger's theory of cognitive dissonance. Leon Festinger's theory, unlike the others I have described, deal with quantitative aspects, as well as qualitative. That's what is so different and revolutionary about Festinger's theory. Robert Wicklund and Jack Brehm (1976), in their book Perspectives on Cognitive Dissonance, write," Most notably, the original statement of dissonance theory included propositions about the resistance-to-change of cognitions and about the proportion of cognitions that are dissonant, both of which allowed powerful and innovative analyses of psychological situations (p.1). The term "dissonance" refers to the relation between two elements. When two elements do not fit together they are considered dissonant. Cognitive dissonance can be broken down into a number of elements. As Brehm and Cohen (1962) write, "A dissonant relationship exist between two cognitive elements when a person possesses one which follows the obverse of another that he possesses. A person experiences dissonance, that is, a motivational tension, when he (or she) has cognitions among which there are one or more dissonant relationships" (p.4).Cognitive dissonance can occur intrapersonally as well as between two or more people. With individual cognitive dissonance the individual longs for consistency within their own mind. Second, there exist dissonance between two or more people. This occurs when two people have differing opinions about a particular issue. This phenomenon may have something to do with varying degrees of knowledge about the issue or different belief systems being enacted. An example of this can be seen by taking a look at the cultures of the West versus cultures of the East. Cultures of the East value loyalty and honor. Cultures of the West have different value systems that often collide with those of the East. Between two parties, dissonance may arise from: (1) logical inconsistency; (2) because of cultural mores: (3) because of a specific opinion; and (4) because of past experience. To reduce cognitive dissonance a person can either reduce the dissonant cognition, or its relative importance can be reduced (Wicklund and Brehm, 1976, p.5). Although the theory assumes that dissonance will be eliminated or reduced, only the thought about taking action to do so is a given. The means employed by any given individual to meet these ends is still open to speculation. Action taken depends solely on the many variables involved, such as ego involvement, commitment, past experiences and so on. We all react differently to dissonant cognitions that we are confronted with. My research attempts to examine the different reactions that people have had to different opinions I have declared which involve them heavily. The area I have chosen to look at is the habits which many of my close friends engage in: smoking. This is often a difficult topic to discuss because it is an addictive habit and very personal to many people. Full well knowing these facts, I attempted to delve in the minds of my friends and put many of the theories afore mentioned to use in the practical world. To undertake my research project I observed my friends in their everyday routines. I chose to attempt to persuade many of my friends to stop smoking. While attempting to undertake this momentous task I observed many of the consistency theories, especially Festinger's theory of cognitive-dissonance. The research method that was used was first hand observation. You could say that I was undertaking a form of ethnographic research. Most of the time I had to become an active member of the persuasion process, or the subject of smoking possibly might not have been talked about. The context I chose was that of my friends at home. All of the participants in the study did not know I was logging their behavior for later use in this research paper. Either myself and/or my friends would be active participants in the persuasion process. The basic premise of the cognitive-dissonance theory is that when two pieces of information do not follow each other we will experience some form of psychological tension, which we will attempt to reduce in some way. Often times, according to Leon Festinger, people attempt to reduce cognitive dissonance whenever possible (Gleitman, 1983, p.12). I noticed many times that my friends were very interested in the topic of quitting their habit, and some at times took the issue personally. When people are personally involved with an issue, much like the use of tobacco, they are much more attentive to the issue (Petty & Cacioppo, 1981, p. 847). For example, on 3/31/96 I told my three friends that I was concerned about how much they had been smoking recently. On the average they are smoking 20 cigarettes a day. One of the girls immediately retaliated with the statement that " her grandmother smoked for nearly all of her life and she is in good health." In this particular instance we can see the basic premise of the consistency theories at work. The girl who said this statement likes me. She also enjoys smoking. When I made the statement that I was concerned with the levels of tobacco consumption she disregarded my opinion by using past experiences as evidence to back her point. She is a friend so I assume she somewhat values my opinion, but she upgraded her opinion of smoking and downgraded my opinion. She experienced some form of dissonance when I stated my opinion. She reduced her dissonance and thus was in balance. This is where Festinger's theory of cognitive dissonance attempts to rationalize her behavior. The other consistency theories do not recognize the degree to which the dissonance exist. If you were to not use Festinger's model, most likely you would have assumed that my opinion would have changed her attitude and actions. After all, I did have a contradictory opinion that did not follow hers, and dissonance was felt. That's what is missing from the balance theory and the congruency theory: "latitudes of attitude". This theory, unlike many others, must factor in the human psyche as a variable. The persuasion process did not occur in this case because my friends attitude towards not smoking was so anti-quitting, that it might be impossible to change. You cannot think of this theory in regards to machines you must look at it from the human perspective. Another example of observable cognitive-dissonance occurred on 4/7/96. The same three friends and myself were watching television. An anti-smoking campaign sponsored by the American Red Cross came on the television. Various facts about the amount of people that die every year from smoking and statistics about the amount of Americans with lung cancer were shared. I asked the girls what they thought about the information. They all agreed that it could happen to them, but they hoped it did not. In this case, I believe dissonance was created by exposure to information. The girls did not like the information and downplayed its validity. Not one of the girls stood up and said, "I am going to quit smoking today, I am really at risk of getting lung cancer!" Once again personal involvement was a given, and once again no action was taken. The girls feel to strong about smoking and refuse to quit. We must ask ourselves what a solution to this problem could be? Why is it that smokers, in the face of grave danger, refuse to reduce dissonance by acting out their urge to quit smoking? The cognitive-dissonance theory is a part of our everyday lives, whether we realize it or not. When we are presented with view points or opinions that differ from our own often times we feel dissonance. We, as human beings, are always striving to keep our lives in balance. Often a balance in our psyche requires that we not heed the warnings of things to come. As I have shown, cognitive-dissonance is utilized to avoid taking action. As many theorist have stated cognitive dissonance does create an internal conflict that causes someone to take action. In the case of smokers, I must regrettably report that smoking is vary rarely avoided, even with dissonance in full effect. Smokers, when presented with hard core data showing a decline in health due to smoking, refuse to head warning. This is evident with all of the "guaranteed" products to help people stop smoking. First there was "The Patch" and now the consumers are intrigued with products, such as Niccorrest Gum. Apparently no matter how much dissonance is felt and to what degree it is felt does not matter. Therefore, it may not be possible to get rid of dissonance or even to reduce it materially by changing one's behavior or feeling. The research I have conducted supports my claim that it is nearly impossible to change the actions of smokers even though massive amounts of cognitive dissonance are felt. I believe that many of the people being observed reduced the overall magnitude of dissonance by adding new cognitive elements. No matter how much dissonance is felt, the smoker will always find elements that are consonant (agreeable) with the fact of smoking. The will power of individuals feeling as though they have to have smoking in their everyday lives is, often times, far to powerful for dissonance to overcome. Perhaps research such as mine can be useful to further research into the area of dissonance and the use of tobacco. Much work still needs to be done in this area. We see so many people dying from lung cancer. Something must be done. Perhaps looking at effective methods of the use of cognitive dissonance can be helpful in this arena. f:\12000 essays\health & humanities (196)\Cystic Fibrosis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ DISEASE Cystic fibrosis is an autosomal recessive trait on chromosome 7. This disorder affects chloride transport resulting in abnormal mucus production. This lifelong illness usually gets more severe with age and can affect both males and females. Symptoms and severity differ from person to person. Cystic fibrosis is the most common fatal inherited disease among whites and the major cause of chronic lung disease in children. 50% of people are expected to live to be 30, but a majority die before age thirteen. 1:2000 whites have cystic fibrosis, 1:17000 blacks, 1:6000 live births, 1:2500 Americans, and 1:20 is a carrier. The genes are inherited in pairs, with one gene coming from each parent to make the pair. Cystic fibrosis occurs when both genes have mutations. A person with cystic fibrosis receives one cystic fibrosis gene from each parent. The parents of a child, with cystic fibrosis, each carry one nonworking copy of the gene and one working copy of the gene. The parents are called cystic fibrosis carriers, and because they have one working gene they have no symptoms. Carrier parents have 1:4 chance to have a child who is a noncarrier of cystic fibrosis, a 1:2 chance to have a child who carries the gene, and a 1:4 chance with each pregnancy to have an affected child. If you have a son or daughter with cystic fibrosis, then you have a 1:1 chance of being a carrier. If you have a brother or sister with CF, you have a 2:3 chance of being a carrier. If you have a niece or nephew with CF, you have a 1:2 chance of being a carrier. If you have an aunt or uncle with CF, you have a 1:3 chance of being a carrier and a 1:4 chance if you have a 1st cousin with CF. Cystic fibrosis affects the lungs in particular. The secretions are thick and sticky rather than thin and watery. This interferes with the removal of dust and germs. It can lead to lung infections and even chronic lung damage. Air passages become clogged with mucus and there is often widespread obstruction of the bronchioles. Expiration is especially difficult. More and more air becomes trapped in the lungs, which results in obstructive emphysema. Atelectasis can occur leaving small areas collapsed. Eventually the chest assumes a barrel shape. The right ventricle, which supplies the lungs, may become strained and enlarged. Clubbing of the finger and toes may occur due to the compensation response indicating the chronic lack of oxygen. Cystic fibrosis affects the pancreas. The mucus clogs the duct and blocks the transfer of enzymes from the pancreas to the intestines. These enzymes are needed to break down food that is necessary for proper growth and weight gain. The mucus in the digestive tract blocks the absorption of necessary nutrients. This is why there is often no weight gain despite good appetites. This can be associated with failure to thrive. The buttocks and thighs atrophy or waste away due to the fat disappearing from main deposit sites. People usually have light colored stools. There is also decreased blood cholesterol due to the poor absorption of fats from the intestine. Cystic fibrosis can also affect the reproductive systems. Men are usually sterile due to the mucus blockage or absence of the vas deferens. Women usually have difficult conceiving, because the mucus interferes with the passage of sperm. Cystic fibrosis is usually diagnosed in childhood. Mild cases may not be detected until adulthood. Common symptoms include chronic cough, wheezing, cyanosis, difficulty breathing, irritability, excessive mucus production, sinus infections, nasal polyps, recurrent pneumonia, poor growth, frequent loose foul-smelling stools, enlarged fingertips, and skin that is salty to the taste. The sweat test is usually used to detect high levels of salt. More than 60m Eq/L of chloride in sweat up to age 20 is diagnostic of CF when 1 or more criteria are present. Levels of 40-60 are highly suggestive. Direct genetic testing or reverse dot-blot can also be used. Amniocentesis is performed between weeks 15-22. Chorionic villus sampling (CVS) can be used to take a piece of placental tissue between weeks 9-12. Labs are also used in diagnosing CF. There is decreased pancreatic enzymes trypsin, lipase, and amylase. Absence of trypsin alone is indicative of CF. One complication of CF is a rare condition known as meconium ileus. The intestine of the newborn becomes obstructed with abnormally thick meconium due to the absence of pancreatic enzymes. The intestine can rupture resulting in shock. Signs and symptoms develop within hours after birth and include absence of stools, vomiting, and abdominal distention. X-rays are used to confirm this and surgery is used to correct the problem. The death rate is high including premature births and most who survive will manifest CF. Nurses in the nursery must be on guard for early detection. Rectal prolapse occurs in infants and children due to poor muscle tone in the rectal area and excessive leanness. It may be related to difficulty passing the frequent bulky stools. Fecal impaction and intussusception or telescoping of the bowel are other bowel complications in infants and toddlers. The liver becomes hard, nodular, and enlarged with progression. There is often edema in the extremities. There may be damage to the eye as a result from swelling and inflammation of the optic nerve. The retina may also hemorrhage. Improper lung function can cause heart strain resulting in death. Osteoporosis results from poor utilization of the fat-soluble vitamin D, which is necessary for proper calcium metabolism. The bones become porous and brittle. Deficiency of vitamin A occurs from the body's inability to absorb fats from which vitamin A is obtained. Sexual development may be delayed and women may experience secondary amenorrhea during exacerbations. There is no cure to date. They have made progress towards a cure. They isolated the gene at U of M in 1989. This was the first human genetic disease to be cloned. They thought it was linked to the trace mineral Boron. Copies of the normal gene were made in 1990. They realized that the protein product of the gene, transmembrane conductance regulator or CFTR, influences chloride transport but were unsure how that led to CF. Gene therapy was experimented in 1993 along with the first drug called Pulmozyme. Ibuprofen was ruled effective in decreasing lung problems in children in 1995. They ruled in 1996 that the bacteria killing agent doesn't function in people with CF due to the excessive salt outside the epithelial cells. This allows pseudomonas and staphlococcus to cause chronic bacterial infections. Treatment of CF includes taking Pancrease, an oral enteric coated pancreatic enzyme preparation, with meals and snacks to help aid in digestion. Fluids should be increased and liberal amounts of salt intake. Fluids are forced to prevent dehydration from frequent stools and excessive sweating. Salt tablets are often used in older children. Frequent high calorie meals and snacks are used to help maintain weight. Don't pile food on a child's tray. Make it attractive and the size should correlate with the child's size. Make mealtime a social time and encourage the child to eat. If he is in a private room, then stay with him or have someone in the room. The nurse feeding an infant must be calm and unhurried. Calories should be increased by 50% along with protein. Fat intake should decrease. Supplement vitamins A,D, and E are used double the recommended daily dose. Skim milk is often added to formula in infancy. Vitamin K is often given. Complex sugars should decrease and simple sugars should increase. Many doctors allow the child to eat what he wants and just increases pancreatic enzymes to provide a "normal" atmosphere. Weights are taken daily. Respiratory relief comes from postural drainage, pursed-lip breathing, general exercise to stimulate cough, deep breathing and coughing exercises, bronchodilators, expectorants, antibiotic use, intermittent aerosol therapy, and the controversial mist tent therapy. Injections should be avoided due to the excessive leanness but if necessary the sites must be monitored and alternated. Pay special attention to the skin. Cleanse the diaper area after each bowel movement. Ointment is often used to protect skin from stools. Expose the buttocks to air when a rash occurs. Pay special attention to the bony areas in order to prevent decubitus ulcers. Change position frequently due to the lack of fat and muscle. This helps to prevent skin breakdown and pneumonia. Don't leave the person staring at a blank wall. Air deodorant is advisable to prevent lingering of offensive odors. Light clothing is recommended to prevent overheating. Loose clothing allows freedom of movement. Good oral hygiene is necessary especially due to dietary deficiencies. Make sure oral hygiene is also performed after postural drainage. Make sure immunizations are up-to-date and the influenza vaccine is also recommended. CF patients are usually in isolation to help prevent secondary infections. Allow for rest. This is very important as is prevention as a whole. CF is hard on children. They often feel different from other children and tire easily. It is hard for them to accept restricted activity. They get really embarrassed about their stools. Give the child straight forward answers regarding his illness to prevent further anxiety. Uninvolved diagrams can be helpful. If he understands, he is more apt to be cooperative. Visiting hours should be flexible for parents. You should be considerate and encouraging. Showing undue concern can, however, cause the child to exaggerate and be demanding for attention. Parents may have knowledge deficit and may need a lot of teaching and explanation. One of the misconception parents have is that their child's intelligence is greatly decreased. Intelligence is not affected. Parents often feel guilty, since this is an inherited disease. The child spends the majority of his time at home due to this lengthy illness. The child is also hospitalized for complications although stays are short to prevent exposure to other infections and illnesses. This puts a financial, physical, and emotional burden on the family. When do the parents find time for each other, themselves, or other children? How do they distribute their time and energy equally and fairly? Parents need encouragement and reassurance. They also need explicit instructions. Parent groups can help along with the Nat'l CF Research Foundation and the 1-800-FIGHT-CF hotline. Parents usually need help from a social worker and financial help for special equipment. Insist parents to get help from other family members or friends and encourage them to get away from it all periodically. Alarm clocks can remind them of medication times. f:\12000 essays\health & humanities (196)\Death.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Death is the thing most people fear the most. I myself however do not, death can mean a lot of things. To me death is a restraint on life, a barrier which holds people from living life to its fullest. I hate being restrained, being set boundaries. However death also deserves respect, because if you do not respect death, you die, literally! What causes death? Well, there are a lot of things that cause death. Disease, old age, Natural and un-natural occurrences, and suicide. The focus of this essay is to tell my views on the leading cause of death. What is the leading cause of death? I believe it is AIDS. AIDS, Acquired Immune Deficiency, is the disease that renders the body's immune system unable to resist invasion by several microorganisms that cause serious infections. AIDS is transmitted by blood, through intimate sexual contact, from infected mothers to their babies in the uterus, and perhaps through infected mother's milk. Currently there is no cure for AIDS, however research is showing hopeful signs. Research has made breakthroughs the past years and have come up with ways to slow things down, but not cure AIDS. There are many ways to prevent AIDS. I believe the leading way is abstinence. No sex until your sure of your sexual partners past sexual history should you consider sex. If you must have sex then have safe sex. Safe sex includes using any instrument or object which does not allow bodily fluids to be exchanged. Preventing AIDS is something we all can do. No one is forced to have sex (unless raped), no one is forced to do drugs with infected needles and no one wants it, so people should get smart and wake up! AIDS, say it, think it over in your head, AIDS will kill people, and AIDS will kill you. Death and AIDS go hand in hand. However we all must be optimistic for the future of everyone. As well as being optimistic one must be understanding for all those who have AIDS, we are only human. f:\12000 essays\health & humanities (196)\Defence Mechanisms.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Sometimes in dealing with anxiety and conflict, a level of the brain also deals with memories. This level is called the unconscious level. Behavior that involves self-deception is a mental defense called defence mechanisms. Some of these defences can be valuable devices. When someone replaces a seemingly impossible goal with a possible one, compensation has beenn used. Redirecting aggresion from hostility to a drive to be sucessful is helpful. This defence is sublimation. While fantasy is a form of escape, it is also a way to work out imaginary solutions to conflicts. Some of these defences can be harmful to you as well as others. When a person lashes out at another person for no reason, it may be the results of something that happeneded earlier that day. The person who was lashed out at is the victim of displaced agression. When these defence mechanisms are taken to extremes and used over a long period of time these defences can be harmful. f:\12000 essays\health & humanities (196)\Deliberate Practice.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Ericsson paper Motor learning 03/08/97 The main point in Ericsson et. Al.(1993) is that in order to achieve expert performance, one must engage in deliberate practice with the explicit goal of constant improvement. This theory further dismisses to a large extent the role of genetics, in which Ericsson reasons that there has been no great correlations between the attainment of superior performance and inherited traits. The purpose of this paper is to show agreement with Ericsson's theory, but only to the extent that deliberate practice is just one of many factors which must be included in order to gain expert status. Also, the task at hand can be a major determinant of how large a role practice plays in improvement. For example, in endurance sports such as marathon running, some are genetically endowed with a high aerobic capacity/VO2 max, and if these "special" people develop and improve their performance through deliberate practice, they can attain expert status. In contrast, the "average" person may also engage in an equal amount of practice but will never be able to achieve that same level of performance because their body is physiologically incapable. Furthermore, physiologist Dr. Astrand contends that up to 90% of the variance in aerobic performance is due to one's genes, regardless of training programs. (McArdle,1994). But sports like golf are probably influenced very little by genetics because skill acquisition far overshadows physical ability. History provides many examples of athletes who apparently has a poor genetic endowment, yet by hard training and motivation went on to international success (Shepard,1987). In conclusion, expert performance is most likely due to a complex interaction of psychological, physiological, and biomechanical factors (Powers, 1994); factors whose importance is dependent on the nature of the task at hand. f:\12000 essays\health & humanities (196)\Depression.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Depression Everybody has "the blues" or "feels down" from time to time. It's normal to feel sad for short periods, especially if something bad had happened in our lives. But those of us who suffer from depression have much more than "the blues", and our feelings can last for a long time. There are many sufferers of this illness; at any one time, 5% of Canadians are depressed, and 10-20% will suffer from it at one point in their lives. But family and friends who've never experienced true depression can have trouble understanding what it's like. Many people find it difficult to think of depression as an illness because their are no obvious physical symptoms. But depression is an illness, which is caused by chemical changes in the brain. Few people think that a physical illness is the sufferer's fault-and no one should think depression is, either. Like any other illness, depression has certain symptoms. Once these have been recognized, you can take measures to treat them. Some are: feeling sad, worried or depressed; feeling as if your life is dreary and unlikely to improve; had crying spells; become irritated over little things that didn't used to bother you; find you no longer enjoy hobbies and activities that once made you happy; feel a lack of self-confidence or feeling like a failure; lost your appetite, or are eating more than usual; have had trouble sleeping, or been sleeping too much; had trouble concentrating and making decisions; and thought about death and/or suicide. Knowing the causes for depression can help depressed people, friends, family understand how painful it is and why it's not possible to "snap out of it". It's still not completely clear why depression happens to some of us and not to others, but their are some triggers: stressful events or a loss, physical illness, hormone levels, and use of certain medications, drugs, or alcohol. Most of us think sadness when we think of depression, but there are other physical, emotional, and mental effects, too. Many depressed people feel helpless, and as if this is the way that they are going to feel forever. They have a lack of energy and a lack of interest in life. It's hard for them to ever imagine feeling happy or excited again. Some may withdraw and be less sociable. They may also become short-tempered and difficult to please. No one can do anything right. The world of depression is a lonely place to be. Physical problems can also occur. Some may have trouble getting to sleep or wake up a lot during the night. Others just want to sleep all the time. It can also cause someone to lose his or her appetite, or want to eat all the time. They may crave sweets, and have stomach pains, constipation, headaches, sweating, a racing heart, or other symptoms. But these days, there are many ways to treat depression. That means no depressed person should suffer needlessly. Medical care, antidepressant medications, counselling, and the support of family and friends are all effective in treating depression. Keep in mind that the most important step in treating depression is SEEKING HELP. If you are depressed, please take a few minutes to call your doctor today, so you can start feeling better as soon as possible. And remember... there is hope. f:\12000 essays\health & humanities (196)\Depressipon.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Depression Depression, it is defined by Webster's Unabridged Edition Dictionary as: in psychology, an emotional condition, either normal or pathological, characterized by discouragement, a feeling of inadequacy, etc. Also as being gloomy; dejected; sad. Depression is the most treatable mental illness, yet the twenty- four million people caught in it's downward spiral each year may feel so isolated that they never seek help. But life can be joyous again, as those who have been fully treated know. There are many different ways to get help, the two major ways are Psychoanalysis and Psychopharmacology. Psychoanalysis is defined by Webster's Unabridged Edition Dictionary as: a method developed by Freud and others, of treating neuroses and some other disorders of the mind. When you undergo psychoanalysis you go to see a psychoanalyst around three times a week and you discuss your feelings and thoughts. It is a very long process. Psychopharmacology is a combination of psychoanalysis and medications. These doctors believe that the problem is a chemical imbalance in the brain. They treat you by giving you certain medicines and talking to you about your thoughts. Some examples of the medicines are Prozac, Elavil, Sinequan, Trofranil, and Norpramin. These medicines have certain chemicals that will replace the certain chemicals that your brain is missing. The most widely used and known medicine is Prozac. It costs $1.60 per capsule , but it is the most effective medicine. I suggest that if you are one of the people that think they are suffering or are suffering from depression but don't seek help should go see somebody, a doctor counselor, or even a family member, because it could become worse and may lead to other problems. Don't become another statistic. f:\12000 essays\health & humanities (196)\Destroying Your Health By Smoking Cigarettes.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Initial Draft: 11/6 Final Draft: 11/13 Destroying Your Health By Smoking Cigarettes If you really want to ruin your health then smoking cigarettes is one of the best ways I know how to do it. Smoking cigarettes cause lung cancer, emphysema, and the one thing that most people notice right off hand is bad breath. If you are into destroying your health, I want you to follow these step so that you can be on your way to an unhappy and unhealthy life, number one buy the cigarettes, number two smoke them, and number three this one is really important never ever quit smoking. I have found that most people who want to destroy themselves quickly will smoke a no filtered brand of cigarettes, so let say you picked out the brand Pallmall-Reds. I understand these are one of the strongest brands of cigarettes you can buy. Yes, there are plenty of other brands of cigarettes out there but why bother going threw all that money to pick the right one when you can take my word on it? These are really strong cigarettes. How do I know, because take one out and look at it, you will notice that there is no filter on the end of it. Due to no filter you will get none of the toxins filtered Without filtering out some of the toxins you will destroy yourself quicker; that is the goal we are seeking, is it not? Lets take out one of our friends (we will call them that to be funny) and look at it. It is about five to six inches in length, maybe a half inch wide with little brown things that look somewhat like coffee grounds inside a thin white paper cylinder. Smell it, a significant number of people actually enjoy the way tobacco products smell, but they will not smoke them. I myself find that ominously odd. Now smoking the cigarette is very important. If you do not smoke it you will not reach your goal to destroy your health. So let us begin with the lighting of the cigarette. Place the cigarette in your mouth, just the tip of it. Do not bother with looking to put the filtered end in your mouth, because if you remember there is no filter on is brand of cigarette. After you have placed our friend in your mouth you will need to tilt your head. Tilting is something most people do when "lighting up," this process is what majority of people do. Now when you tilt your head it really does not make a difference which way you tilt it. In my opinion when tilting occurs you will tilt left or right depending on which hand you use, then again I am no expert on tilting to "light up." At this time we will light the end that is opposite of the end that is in our mouths. We will call this end of the cigarette the "cherry," this term is slang and the only slang term I know. Notice the reddish, orange glow that occurs after you have lit the "cherry." Some people say that is it a beautiful color. Now that we have started the procedure to destroying your health, let make sure we never forget to inhale. Inhaling is how you get the cigarette smoke into your lungs, which in turn (somehow) places the toxins into your body. The proper why to inhale cigarette smoke is to exhale (letting all the air out of you lungs) first, then place the cigarette in your mouth as we discussed before and draw in on the cigarette. Inhaling is just like taking in a deep breath. If you need to practice before you start with the real thing, I would recommend do that. I would recommend doing a little practicing first. All right now that we are on the right road to destroying our health lets remember that we should never ever try to quit. Quitting is something that well only help you in making your health better, and that is not the goal we have set for ourselves. Cigarettes help keep you thin and give you energy if you quit you will only get remarkably obese on top of becoming extraordinarily tired. Sure maybe that only happens to some people, but if you do quit you will most likely become a healthier person in the long run. We can not let that happen. Now can we? Remember the steps I have laid out for you buy the cigarettes a strong non-filtered one is the best. Smoke them, after you have practiced try getting up to at least six packs a day, and the last and most important thing never ever try to quit, it will only make your life a living hell. Besides this is the best way to destroy your health, and is that not what you are trying to do. Just think you will be just like thousands maybe millions of other people who are on the same road. f:\12000 essays\health & humanities (196)\DIABETES.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ DIABETES This disease is caused by defective carbohydrate metabolism. It causes large amounts of sugar in the blood and urine. It can damage the kidneys, heart, eyes, limbs, and endanger pregnancy. About five percent of the United States population has it and about half are undiagnosed. A diabetic that is treated life span is lowered by one-third There are two types of diabetes. Type I, insulin-dependent diabetes mellitus (IDDM). And type II, non-insulin-dependent diabetes mellitus (NIDDM). Type I This type usually occurs in children and young adults, it is known as one of the autoimmune diseases. It is 10-15 percent of all cases. The pancreas lets out insulin that lets sugar glucose into all tissues in the body and in this type of diabetes most or all of this insulin is not made. So all the extra glucose is let out through urine. If untreated this type could be fatal quickly. The body cannot get enough energy from tissue glucose so it starts to break down stored fat. With this people loose a lot of weight and they have fatigue. Your blood becomes acidic and respiration becomes abnormal. People usually die from diabetic coma until they figured out how to use insulin therapy. In both forms it could cause a kidney disease from high blood sugar levels; bad sight from blood vessels in eyes rupturing, less blood going to the limbs could make them have to cut them off. They have high blood pressure which increases heart attacks and strokes in diabetes too. Type II This type is found in mostly in people over 40 it progresses slowly unlike type I. The insulin in the pancreas is produced in good levels but does not work right. It does not let the glucose in to the tissues just like in type I. The people in type II are usually over weight. Treatment The treatment for both types is insulin injections and changes in their diet. They must spread out every thing that they eat in a day so they sugar comes in slow. For type II they have to loose weigh and exercise more. Some people test their own blood sugar levels throughout the day and have insulin pumps. DIABETES Robert Quinn Brick Memorial High School January 23, 1997 f:\12000 essays\health & humanities (196)\Dietary Issues.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ In today's society nearly everyone follows some kind of dietary guidelines. Whether it is in the goal of losing weight, gaining weight or just simply to maintain it, people are jumping onto the dietary band-wagon. A diet is basically to take food according to rule, a mode of living in reference to nourishment. There are various types of diets that one can follow; a high or low calorie diet, low fat diets, diets modified in protein, minerals, water, and carbohydrates, and so the list goes on. Many business enterprises base their entire corporations into the field of weight loss. Many of these diet programs are merely fads that lure desperate people in with their guarantees to lose so many pounds or inches in an " x " amount of time. There are also many pills that one can take, but they are not always safe and can be very damaging in the long run. It is not all people that are on weight loss programs though. Many athletes are on strict programs to gain weight. However this kind of desired weight is not measured in fat but in muscle mass. Many muscle and fitness magazines will feature advertisements and articles for such gains in body mass. Advertisements for diets can sometimes be very dangerous though. Pretty well all the people used in these particular ads are slim and beautiful and it can therefor be very misinterpreting to someone who is overweight. The pressure of being fit can lead to very damaging disorders such as anorexia and bulimia. These two very serious conditions affect a very large amount of women and men in North America these days and can be quite lethal if not cured. So it is important to be careful not to do any physical or psychological harm to one self when trying to lose weight. When embarking into any kind of diet it is extremely important that one gets the sufficient amount of nutrients from their food and/or supplements. A proper diet must consist of more than simply a glass of water and a piece of fruit per meal. One must have a certain daily intake of specific vitamins and minerals to stay in good health. If one were to follow the RDA's (recommended daily allowance) guidelines, one has to be sure that the food that is consumed contains the proper amount of nutrients that is so suggested. A lot of the foods that we consume today do not contain the amount of vitamins and minerals that the U.S. RDA have claimed. The reason being our obsession with colour, taste, and texture in the food we eat and our lack of concern about it actually being nutritious or not. Thousands of damaging pesticides, preservatives, chemicals and colouring are raping our food of its nutritional value these days. Therefor someone who is planning on going on a restricted calorie diet must be careful in how they plan their daily food intake. With the help of a nutritional guide that contains a table of food composition one can keep an accurate record of their daily intake of protein, carbohydrates, fibres, fats, minerals, and vitamins (see page ). This will enable a person on a restricted weight loss program to be assured that he or she is getting all the necessary nutrients for a well balanced diet. Along with a proper diet one must also have some kind of exercise program in order to lose the undesired weight and keep it off. If a person restricts themselves to dieting alone without any type of physical exercise the human body will eventually adjust its metabolism to the reduced calorie intake. Thus when the person returns to their regular calorie consumption they will gain the weight right back. Medical professionals agree that 30 minutes of moderately vigorous exercise performed three times a week will elevate one's metabolism, and a higher metabolism burns more calories. In order to lose one pound of fat, one has to burn off an extra 3500 calories on top of the calories that they consumed in their meals. So in most cases the phrase "No pain, no gain", still holds true. However, many people elect to take the easier route in trying to lose those extra pounds. Billions of dollars are spent each year on diet pills, fad diets, and other weight loss promises. These enterprises thrive on the ever growing amount of obese people and their need for a quick and easy solution. One can't turn on the television or flip through the pages of a magazine without seeing some kind of diet remedy, that according to the manufacturer works wonders. "Guaranteed to lose weight or your money back" is a catch phrase that has lured many into wasting their money in order to look good. These kinds of advertisements are especially popular around the holidays, Christmas being the main one. The weight loss companies pump out the ads during this time of the year because they know that the average North American puts on a sweltering seven pounds of undesired baggage over this short period of time. Companies such as Weight Watchers and Jenny Craig have been successful because they supervise and keep track of their customers. These kinds of weight loss clinics also encourage their customers to keep a record of their progress and maintain their diet schedule. Many other diet plans are merely fads that make too many promises and have diets designed to bring about quick weight loss that are usually unbalanced nutritionally and are sometimes dangerous. Diet pills are another poor form of treatment choices for obesity. These pills depress the appetite temporarily; often, physician-prescribed amphetamines (speed). It is generally agreed that these drugs are of little value for weight loss and that their use can cause a dangerous dependency. Another form of diet pills that can often be seen used by bodybuilders is water pills. These are diuretics that promote the excretion of water from the body. The water loss results in some weight loss, but this loss can be dangerous because the overweight subject has a small percentage of water than a person of normal weight. Bodybuilders sometimes use these water pills to look more "cut" because they give an appearance that the skin is tightly pressed against the muscle. Dehydration can result from the use of these pills and are therefor can sometimes be considered to be hazardous to one's health. To date there has yet to be a safe effective and quick way to lose weight and keep it off, however with the extensive research being made in this area it might not be long. As we all know it is not difficult to put on weight, but to put on the proper kind of weight can be just as hard as losing it. This proper kind of weight that is spoken of is muscle mass. Muscle mass is the building of the muscle fibres in the body and the only way to increase this mass is by hard physical activity. A low fat, high carb diet is also necessary to be able to keep a high energy level for the physical load that is required for building up the muscles. For the muscle fibres to be stimulated to grow a certain amount of resistance has to be applied to them. This is done by working out with weights is a gym or elsewhere. In the recuperation phase, the muscles needs protein to repair itself and grow. When trying to gain desired weight by firming up the body one must also have a healthy and strict diet. This includes proper amounts of vitamins, minerals and protein along with a low fat, low sugar, and low sodium intake. Many people cannot cope with the pressure of society's view of a healthy human body. With all the slim supermodels and big muscular guys in every single ad, people are desperately trying to obtain this hard to obtain feat. A major concern of many teenagers, especially of girls, is dieting to maintain a slim and beautiful figure. To accomplish this, many go on fad diets that are neither safe nor effective. Two special eating disorders related to dieting often arise: anorexia and bulimia. Anorexia nervosa is an extreme preoccupation with weight loss that seriously endangers the health and even the life of the dieter. It arises only in developed countries where food is abundant, suggestion that it is a societal problem. Although no two persons with anorexia nervosa are alike, certain features are considered typical of the condition. The anorexic is almost always female and in her mid-teens. She is usually from an educated, middle-class, success-oriented, weight-conscious family that is proud of her and is surprised to see her develop a problem. The major problem with these young teenagers is that even after they are well below the average weight they still don't stop. Weight loss has by now become an obsession. If the victim does not get treatment she may soon experience permanent brain damage and chronic invalidism or death. Another serious eating disorder is bulimia, periodic binge eating ("pigging out") alternating with intervals of dieting or self-starvation. Bulimia may accompany anorexia or may occur separately. The binge would end when it would hurt to eat any more or when the person goes to sleep, induces vomiting, or is interrupted. Anorexia and bulimia often arise in young people, but the problems don't always resolve in adolescence. People with anorexia and bulimia may retain abnormal eating behaviours and fearful attitudes toward food throughout their entire adult lives. With so many different diet programs out on the market that promise to make you lose weight fast it is hard not to be tempted. One must be careful however, because many of the diets that promise it all are actually quite dangerous, so one must not get suckered in without knowing what is involved. In order to reduce body weight, all doctors agree, one must reduce their calorie intake and/or increase their energy expenditure. Whether you consume them or burn them - and whether it's protein, fat or carbs - every calorie counts, so you might as well learn to count them. One can start by a book that lists foods and their nutritional value, then bring it to the dinner table and look up the foods their eating. Gradually, one will learn to compromise their calories and make better food choices. Once that is done, weight loss will be obtained. Others desire to gain weight which can also be very difficult, if he or she trying to gain muscle mass that is. A proper diet and a hard physical workout program is required and of course lots of dedication. The most important thing about dieting is that one has to remember to do it for themselves and not for the sake of others, and to also be careful in doing so. Dietary Guidelines for North Americans and Suggestions for Food Choices 1. Eat a variety of foods daily. Include these foods every day: fruits and vegetables; whole-grain and enriched breads and cereals; milk and milk products; meats; fish; poultry and eggs; dried beans and peas. 2. Maintain ideal weight. Increase physical activity; reduce calories by eating fewer fatty foods and sweets and less sugar and by avoiding too much alcohol; lose weight gradually. 3. Avoid too much fat, saturated fat, and cholesterol. Choose low-fat protein sources, such as lean meats, fish, poultry, and dried beans and peas; use eggs and organ meats in moderation; limit intake of fats on and in foods; trim fats from meats; broil, bake, or boil, don't fry; read food labels for fat contents. 4. Eat foods with adequate starch and fibre. Substitute starches for fats and sugars; select whole-grain breads and cereal, fruits and vegetables, dried beans and peas, and nuts to increase fibre and starch intake. 5. Avoid too much sugar. Use less sugar, syrup, and honey; reduce concentrated sweets, such as candy, soft drinks, cookies, and the like; select fresh fruit or fruits canned in light syrup or in their own juices; read food labels - sucrose, glucose, dextrose, maltose, lactose, fructose, syrups, and honey are all sugars; eat sugar less often to reduce dental caries. 7. If you drink alcohol, do so in moderation. Individuals who drink should limit all alcoholic beverages (including wine, beer, liquors, and so on) to one or two drinks per day. Note that the use of alcoholic beverages during pregnancy can result in the development of birth defects and mental retardation called Foetal Alcohol Syndrome. Table of Food Composition Gpr Ref Food description Measure Wt H O Ener Prot Carb (g) (%) (kcal) (g) (g) Beverages Alcoholic: Beer: 1 1 Regular (12 fl oz) 1 c 356 92 146 1 13 1 2 Light (12 fl oz) 1 c 354 95 100 1 5 Gin, rum, vodka, whisky: 1 3 80 proof 1 fl oz 42 67 97 0 <.1 1 4 86 proof 1 fl oz 42 64 105 0 <.1 1 5 90 proof 1 fl oz 42 62 110 0 <.1 Liqueur: 1 1359 Coffee Liqueur, 53 proof 1 fl oz 52 31 174 0 24 1 1360 Coffee & Cream liqueur, 34 proof 1 fl oz 47 47 154 1 10 1 1361 Creme de menthe, 72 proof 1 fl oz 50 28 186 0 21 Wine: 1 6 Dessert (4 fl oz) c 118 72 181 <1 14 1 7 Red 3 fl oz 103 88 74 <1 2 1 8 Rose 3 fl oz 103 89 73 <1 2 1 9 White medium 3 fl oz 103 90 70 <1 1 Carbonated: 1 10 Club soda (12 fl oz) 1 fl oz 355 100 0 0 0 1 11 Cola beverage (12 fl oz) 1 fl oz 370 89 151 0 39 1 12 Diet cola (12 fl oz) 1 fl oz 355 100 2 0 <1 1 13 Diet soda (12 fl oz) 1 fl oz 355 100 2 0 <1 1 14 Ginger ale (12 fl oz) 1 fl oz 366 91 124 0 32 1 15 Grape soda (12 fl oz) 1 fl oz 372 89 161 0 42 1 16 Lemon-lime (12 fl oz) 1 fl oz 368 90 149 0 38 1 17 Orange (12 fl oz) 1 fl oz 372 88 177 0 46 1 18 Pepper-type soda (12 fl oz) 1 fl oz 368 89 151 0 38 1 19 Root beer (12 fl oz) 1 fl oz 370 89 152 <1 39 Coffee: 1 20 Brewed 1 c 240 99 2 <1 1 1 21 Prepared from instant 1 c 240 99 2 <1 1 Fruit drinks, noncarbonated 1 22 Fruit punch drink, canned 1 c 253 88 118 <1 30 1 1358 Gatorade 1 c 230 99 39 0 11 1 23 Grape drink, canned 1 c 250 88 112 0 35 1 1304 Koolade, sweetened w/ sugar 1 c 240 100 110 0 25 1 1356 Koolade, sweetened w/ nutraswt. 1 c 240 100 4 0 0 Lemonade, frozen: 1 26 Concentrate (6-oz can) 1 c 219 52 397 1 103 1 27 Lemonade prepared from 1 c 248 89 100 <1 26 frozen concentrate Dietary Fiber Fat Fat Breakdown (g) Chol Calc Iron Magn Phos (g) (g) Sat Mono Poly (mg) (mg) (mg) (mg) (mg) 1 0 0 0 0 0 18 .11 23 44 1 0 0 0 0 0 18 .14 18 43 0 0 0 0 0 0 0 .02 0 2 0 0 0 0 0 0 0 .02 0 2 0 0 0 0 0 0 0 .02 0 2 0 <1 .1 t .1 0 1 .03 1 3 0 7 4.5 2.1 .3 - 7 .06 1 23 0 <1 t t .1 0 0 .04 0 0 0 0 0 0 0 0 9 .24 11 11 0 0 0 0 0 0 8 .44 13 14 0 0 0 0 0 0 9 .39 10 15 0 0 0 0 0 0 9 .33 11 14 0 0 0 0 0 0 17 .15 4 0 0 0 0 0 0 0 9 .12 3 46 0 0 0 0 0 0 12 .11 4 30 0 0 0 0 0 0 14 .14 3 38 0 0 0 0 0 0 12 .66 3 1 0 0 0 0 0 0 12 .31 4 0 0 0 0 0 0 0 9 .25 2 1 0 0 0 0 0 0 19 .23 4 4 0 0 0 0 0 0 12 .14 1 41 0 0 0 0 0 0 19 .19 4 2 <1 0 0 0 0 0 4 .96 14 3 0 0 0 0 0 0 8 .12 9 8 0 <1 t t t 0 19 .52 5 3 0 0 0 0 0 0 23 - - 0 <1 <1 t t t 0 3 .41 5 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 <1 .1 t .1 0 15 1.58 11 19 <1 <1 t t t 0 4 .41 3 5 Pota Sodi Zinc VT- A Thia Ribo Niac V - B6 Fola VT - C (mg) (mg) (mg) (RE) (mg) (mg) (mg) (mg) ( g) (mg) 89 19 .07 0 .02 .09 1.61 .18 21 0 64 10 .11 0 .03 .11 1.39 .12 15 0 1 <1 .02 0 <.01 <.01 <.01 t 0 0 1 <1 .02 0 <.01 <.01 <.01 0 0 0 1 <1 .02 0 <.01 <.01 <.01 0 0 0 15 4 .01 0 <.01 .01 .08 - 0 0 15 43 .08 - 0 0 .04 - 0 0 0 3 - 0 0 0 <.01 0 0 - 109 11 .08 0 .02 .02 .25 0 <1 0 115 6 .01 0 <.01 .03 .08 .04 2 0 102 5 .06 0 <.01 .02 .08 .03 1 0 82 5 .07 0 <.01 <.01 .07 .01 <1 0 6 75 .36 0 0 0 0 0 0 0 4 15 .05 0 0 0 0 0 0 0 0 21 .28 0 .02 .08 0 0 0 0 7 21 .10 0 0 0 0 0 0 0 5 25 .18 0 0 0 0 0 0 0 3 57 .26 0 0 0 0 0 0 0 4 41 .18 0 0 0 .06 0 0 0 9 46 .38 0 0 0 0 0 0 0 2 38 .15 0 0 0 0 0 0 0 3 49 .26 0 0 0 0 0 0 0 130 5 .08 0 0 .02 .53 0 <1 0 87 8 .07 0 0 <.01 .69 0 0 0 64 56 .31 4 .06 .06 .05 0 3 75 23 123 - 0 - - - - - - 13 16 .28 <1 .08 .02 .07 .02 1 85 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 6 19 8 .17 21 .06 .21 .16 .06 22 39 5 8 .05 5 .02 .05 .04 .02 6 10 Bibliography Whitney, Eleanor Noss. Nutrition & Diet Therapy : Principals and Practice (second edition). West Publishing Company, New York, 1985. Whitney, Eleanor Noss. Nutrition & Diet Therapy : Principals and Practice (first edition). West Publishing Company, New York, 1986. Joe Weider's Muscle and Fitness magazine. January 1997 edition. Brute Enterprises Inc.. California, 1997. (page 103) World Encyclopaedia. Volume 2. Chicago, . Anorexia (page 34). Rosenberg, Dr. Harold. Stora Lakarboken om Vitaminterapi. Lerchs Forlag AB. Johanneshov, Sverige, 1975. Footnotes 1. Whitney, Eleanor Noss. Nutrition & Diet Therapy : Principals and Practice (second edition). West Publishing Company. New York, 1986. *Page 11. 2. Whitney, Eleanor Noss. Nutrition & Diet Therapy : Principals and Practice (first edition). West Publishing Company. New York, 1985. *Page 552. 3. Whitney, Eleanor Noss. Nutrition & Diet Therapy : Principals and Practice (first edition). West Publishing Company. New York, 1985. *Page 519. Recommended Nutrient Intakes for Canadians Fat-Soluble Vitamins ----------------------------------- Weight Protein Vitamin A Vitamin B Vitamin E Age Sex (kg) (g/day) (RE/day) ( g/day) (mg/day) Months 0-2 Both 4.5 11 400 10 3 3-5 Both 7.0 14 400 10 3 6-8 Both 8.5 17 400 10 3 9-11 Both 9.5 18 400 10 3 Years 1 Both 11 19 400 10 3 2-3 Both 14 22 400 5 4 4-6 Both 18 26 500 5 5 7-9 M 25 30 700 2.5 7 F 25 30 700 2.5 6 10-12 M 34 38 800 2.5 8 F 36 40 800 2.5 7 13-15 M 50 50 900 2.5 9 F 48 42 800 2.5 7 16-18 M 62 55 1000 2.5 10 F 53 43 800 2.5 7 19-24 M 71 58 1000 2.5 10 F 58 43 800 2.5 7 25-49 M 74 61 1000 2.5 9 F 59 44 800 2.5 6 50-74 M 73 60 1000 2.5 7 F 63 47 800 2 5 6 75+ M 69 57 1000 2.5 6 F 64 47 800 2.5 5 f:\12000 essays\health & humanities (196)\digestive system.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Heartburn Heartburn is the inflammation of the esophagus. It is also known as pyrosis. The major cause of heartburn is reflux. This is when the esophagus bottom edges are not tightly shut, and acid moves form the stomach up into the esophagus. Hiatus Hernia's also cause heartburn. This also occurs when the ends of the esophagus are not shut, and the stomach lining moves up the esophagus. There are many other causes of heartburn, some of which being: obesity, drinking hot or cold beverages, extensive alcohol usage, smoking, foods (acidic), certain types of medication, and types of syndromes (Zollinger, and Ellison). Posture also causes heartburn, for example, if after eating a large fairly acidic food, and lying straight back, the acid moves back from the stomach. Also, if you lean over while working, pressure builds in the organs, pushing the acids upwards. Heartburn is often very uncomfortable for the individual who has it. There are not many symptoms, but the ones most commonly found are, a burning sensation in the chest and upper abdomen, sore throat, and when the mouth sometimes fills with a liquid called water brash. Heartburn has many affects on the body, but I will focus now on the effect on the digestive system. Heartburn causes ulcers, which eat through the mucous layer of the organs in the digestive tract by means of enzymes and acids. It also causes an irritable bowel through syndromes. Stinosis is also caused by heartburn. This is when the esophagus passage narrows. Heartburn is treated by taking He blackens, for example Axid and Pepsid. Proton Pump Inhibitors (Lozac), is the most powerful treatment of heartburn. Sulcrates are used to coat the lining of the stomach against ulcers. Antacids, like Rolaids, are used, as are Calcium Channel Blackens. To cure the problems of heartburn, you must cut down on the causes. Gallstones A gallstone is a stone about the size of a pea, or marble which is made in the gallbladder. It usually consists of bile, cholesterol, uric acid, and calcium phosphorus. The major cause of gallstones is the precipitation of chemicals in the gallbladder by stasis, which means that the substance is still. The liver produces bile, which is stored in the gallbladder until fatty foods come along, this is when the bile is released to digest the fat. The same happens with cholesterol secreted by the liver. When the bile or cholesterol is in the gallbladder for a period of time, the substance concentrates, forming stones. Also, an excess of certain bio-chemicals in the bloodstream (cholesterol) cause them. Blockage of the gallbladder neck, and infections are other causes of gallstones. Symptoms of gallstones are, mostly pain in the right-upper quadrant, but it could be anywhere in the abdomen, chest, or back. Bloating of the body (gas), and an accumulation of bile in the bloodstream (jaundice), are other symptoms of gallstones in the body. Gallstones affect the digestive system is a few ways. These are that it causes diarrhea, fat mal-absorption occurs, the gallbladder might rupture, and an obstruction of the bowel might be present. To treat gallstone problems, you can have surgery done to have them taken out (laparoscopic), the stones may be dissolved by chemicals and/or drugs, and the stones might be fragmented by an ultrasound. The cure for gallstones is the treatment done, and the reduction of the causes. f:\12000 essays\health & humanities (196)\diphtheria.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Diphtheria (Corynebacterium diphtheriae) Corynebacteria are Gram-positive, aerobic, nonmotile, rod-shaped bacteria related to the Actinomycetes. They do not form spores or branch as do the actinomycetes, but they have the characteristic of forming irregular shaped, club-shaped or V-shaped arrangements in normal growth. They undergo snapping movements just after cell division which brings them into characteristic arrangements resembling Chinese letters. The genus Corynebacterium consists of a diverse group of bacteria including animal and plant pathogens, as well as saprophytes. Some corynebacteria are part of the normal flora of humans, finding a suitable niche in virtually every anatomic site. The best known and most widely studied species is Corynebacterium diphtheriae, the causal agent of the disease diphtheria. History and Background No bacterial disease of humans has been as successfully studied as diphtheria. The etiology, mode of transmission, pathogenic mechanism and molecular basis of exotoxin structure, function, and action have been clearly established. Consequently, highly effective methods of treatment and prevention of diphtheria have been developed. The study of Corynebacterium diphtheriae traces closely the development of medical microbiology, immunology and molecular biology. Many contributions to these fields, as well as to our understanding of host-bacterial interactions, have been made studying diphtheria and the diphtheria toxin. Hippocrates provided the first clinical description of diphtheria in the 4th century B.C. There are also references to the disease in ancient Syria and Egypt. In the 17th century, murderous epidemics of diphtheria swept Europe; in Spain "El garatillo" (the strangler"), in Italy and Sicily, "the gullet disease". In the 18th century, the disease reached the American colonies and reached epidemic proportions in 1735. Often, whole families died of the disease in a few weeks. The bacterium that caused diphtheria was first described by Klebs in 1883, and was cultivated by Loeffler in 1884, who applied Koch's postulates and properly identified Corynebacterium diphtheriae as the agent of the disease. In 1884, Loeffler concluded that C. diphtheriae produced a soluble toxin, and thereby provided the first description of a bacterial exotoxin. In 1888, Roux and Yersin demonstrated the presence of the toxin in the cell-free culture fluid of C. diphtheriae which, when injected into suitable lab animals, caused the systemic manifestation of diphtheria. Two years later, von Behring and Kitasato succeeded in immunizing guinea pigs with a heat-attenuated form of the toxin and demonstrated that the sera of immunized animals contained an antitoxin capable of protecting other susceptible animals against the disease. This modified toxin was suitable for immunizing animals to obtain antitoxin but was found to cause severe local reactions in humans and could not be used as a vaccine. In 1909, Theobald Smith, in the U.S., demonstrated that diphtheria toxin neutralized by antitoxin (forming a Toxin-Anti-Toxin complex, TAT) remained immunogenic and eliminated local reactions seen in the modified toxin. For some years, beginning about 1910, TAT was used for active immunization against diphtheria. TAT had two undesirable characteristics as a vaccine. First, the toxin used was highly toxic, and the quantity injected could result in a fatal toxemia unless the toxin was fully neutralized by antitoxin. Second, the antitoxin mixture was horse serum, the components of which tended to be allergenic and to sensitize individuals to the serum. In 1913, Schick designed a skin test as a means of determining susceptibility or immunity to diphtheria in humans. Diphtheria toxin will cause an inflammatory reaction when very small amounts are injected intracutaneously. The Schick Test involves injecting a very small dose of the toxin under the skin of the forearm and evaluating the injection site after 48 hours. A positive test (inflammatory reaction) indicates susceptibility (nonimmunity). A negative test (no reaction) indicates immunity (antibody neutralizes toxin). In 1929, Ramon demonstrated the conversion of diphtheria toxin to its nontoxic, but antigenic, equivalent (toxoid) by using formaldehyde. He provided humanity with one of the safest and surest vaccines of all time-the diphtheria toxoid. In 1951, Freeman made the remarkable discovery that pathogenic (toxigenic) strains of C. diphtheriae are lysogenic, (i.e., are infected by a temperate B phage), while non lysogenized strains are avirulent. Subsequently, it was shown that the gene for toxin production is located on the DNA of the B phage. In the early 1960s, Pappenheimer and his group at Harvard conducted experiments on the mechanism of a action of the diphtheria toxin. They studied the effects of the toxin in HeLa cell cultures and in cell-free systems, and concluded that the toxin inhibited protein synthesis by blocking the transfer of amino acids from tRNA to the growing polypeptide chain on the ribosome. They found that this action of the toxin could be neutralized by prior treatment with diphtheria antitoxin. Subsequently, the exact mechanism of action of the toxin was shown, and the toxin has become a classic model of a bacterial exotoxin. Human Disease Diphtheria is a rapidly developing, acute, febrile infection which involves both local and systemic pathology. A local lesion develops in the upper respiratory tract and involves necrotic injury to epithelial cells. As a result of this injury, blood plasma leaks into the area and a fibrin network forms which is interlaced with with rapidly- growing C. diphtheriae cells. This membranous network covers over the site of the local lesion and is referred to as the pseudomembrane. The diphtheria bacilli do not tend to invade tissues below or away from the surface epithelial cells at the site of the local lesion. At this site they produce the toxin that is absorbed and disseminated through lymph channels and blood to the susceptible tissues of the body. Degenerative changes in these tissues, which include heart, muscle, peripheral nerves, adrenals, kidneys, liver and spleen, result in the systemic pathology of the disease. In parts of the world where diphtheria still occurs, it is primarily a disease of children, and most individuals who survive infancy and childhood have acquired immunity to diphtheria. In earlier times, when nonimmune populations (i.e., Native Americans) were exposed to the disease, people of all ages were infected and killed. Pathogenicity The pathogenicity of Corynebacterium diphtheriae includes two distinct phenomena: 1.Invasion of the local tissues of the throat, which requires colonization and subsequent bacterial proliferation. Nothing is known about the adherence mechanisms of this pathogen. 2.Toxigenesis: bacterial production of the diphtheria toxin. The virulence of C. diphtheriae cannot be attributed to toxigenicity alone, since a distinct invasive phase apparently precedes toxigenesis. However, it cannot be ruled out that the diphtheria toxin plays a (essential?) role in the colonization process due to its short-range effects at the colonization site. Three strains of Corynebacterium diphtheriae are recognized, gravis, intermedius and mitis. They are listed here by falling order of the severity of the disease that they produce in humans. All strains produce the identical toxin and are capable of colonizing the throat. The differences in virulence between the three strains can be explained by their differing abilities to produce the toxin in rate and quantity, and by their differing growth rates. The gravis strain has a generation time (in vitro) of 60 minutes; the intermedius strain has a generation time of about 100 minutes; and the mitis stain has a generation time of about 180 minutes. The faster growing strains typically produce a larger colony on most growth media. In the throat (in vivo), a faster growth rate may allow the organism to deplete the local iron supply more rapidly in the invaded tissues, thereby allowing earlier or greater production of the diphtheria toxin. Also, if the kinetics of toxin production follow the kinetics of bacterial growth, the faster growing variety would achieve an effective level of toxin before the slow growing varieties. Toxigenicity Two factors have great influence on the ability of Corynebacterium diphtheriae to produce the diphtheria toxin: (1) low extracellular concentrations of iron and (2) the presence of a lysogenic prophage in the bacterial chromosome. The gene for toxin production occurs on the chromosome of the prophage, but a bacterial repressor protein controls the expression of this gene. The repressor is activated by iron, and it is in this way that iron influences toxin production. High yields of toxin are synthesized only by lysogenic bacteria under conditions of iron deficiency. The role of iron. In artificial culture the most important factor controlling yield of the toxin is the concentration of inorganic iron (Fe++ or Fe+++) present in the culture medium. Toxin is synthesized in high yield only after the exogenous supply of iron has become exhausted (This has practical importance for the industrial production of toxin to make toxoid. Under the appropriate conditions of iron starvation, C. diphtheriae will synthesize diphtheria toxin as 5% of its total protein!). Presumably, this phenomenon takes place in vivo as well. The bacterium may not produce maximal amounts of toxin until the iron supply in tissues of the upper respiratory tract has become depleted. It is the regulation of toxin production in the bacterium that is partially controlled by iron. The tox gene is regulated by a mechanism of negative control wherein a repressor molecule, product of the DtxR gene, is activated by iron. The active repressor binds to the tox gene operator and prevents transcription. When iron is removed from the repressor (under growth conditions of iron limitation), derepression occurs, the repressor is inactivated and transcription of the tox genes can occur. Iron is referred to as a corepressor since it is required for repression of the toxin gene. The role of B-phage. Only those strains of Corynebacterium diphtheriae that that are lysogenized by a specific Beta-phage produce diphtheria toxin. A phage lytic cycle is not necessary for toxin production or release. The phage contains the structural gene for the toxin molecule, since lysogeny by various mutated Beta phages leads to production of nontoxic but antigenically-related material (called CRM for "cross-reacting material"). CRMs have shorter chain length than the diphtheria toxin molecule but cross react with diphtheria antitoxins due to their antigenic similarities to the toxin. The properties of CRMs established beyond a doubt that the tox genes resided on the phage chromosome rather than the bacterial chromosome. Even though the tox gene is not part of the bacterial chromosome the regulation of toxin production is under bacterial control since the DtxR (regulatory) gene is on bacterial chromosome and toxin production depends upon bacterial iron metabolism. It is of some interest to speculate on the role of the diphtheria toxin in the natural history of the bacterium. Of what value should it be to an organism to synthesize up to 5% of its total protein as a toxin that specifically inhibits protein synthesis in eukaryotes (and archaebacteria)? Possibly the toxin assists colonization of the throat (or skin) by killing epithelial cells or neutrophils. There is no evidence to suggest a key role of the toxin in the life cycle of the organism. Since mass immunization against diphtheria has been practiced, the disease has virtually disappeared, and C. diphtheriae is no longer a component of the normal flora of the human throat and pharynx. It may be that the toxin played a key role in the colonization of the throat in nonimmune individuals and, as a consequence of exhaustive immunization, toxigenic strains have become virtually extinct. Mode of Action of the Diphtheria Toxin The diphtheria toxin is a two component bacterial exotoxin synthesized as a single polypeptide chain containing an A (active) domain and a B (binding) domain. Proteolytic nicking of the secreted form of the toxin separates the A chain from the B chain The toxin binds to a specific receptor (now known as the HB-EGF receptor) on susceptible cells and enters by receptor-mediated endocytosis. Acidification of the endosome vesicle results in unfolding of the protein and insertion of a segment into the endosomal membrane. Apparently as a result of activity on the endosome membrane, the A subunit is cleaved and released from the B subunit as it inserts and passes through the membrane. Once in the cytoplasm, the A fragment regains its conformation and its enzymatic activity. Fragment A catalyzes the transfer of ADP-ribose from NAD to the eukaryotic Elongation Factor 2 which inhibits the function of the latter in protein synthesis. Ultimately, inactivation of all of the host cell EF-2 molecules causes death of the cell. Attachment of the ADP ribosyyl group occurs at an unusual derivative of histadine called diphthamide. NAD ATox EF-2-ADP-Ribose Nicotinamide ATox-ADP-Ribose EF-2 Mode of Action of the Diphtheria Toxin In vitro, the native diphtheria toxin is inactive and can be activated by trypsin in the presence of thiol. The enzymatic activity of fragment A is masked in the intact toxin. Fragment B is required to bind the native toxin to its cognate receptor and to permit the escape of fragment A from the endosome. The C terminal end of Fragment B contains the peptide region that attaches to the HB-EGF receptor on the sensitive cell membrane, and the N-terminal end is a strongly hydrophobic region which will insert into a membrane lipid bilayer. The specific membrane receptor, heparin-binding epidermal growth factor (HB-EGF) precursor is a protein on the surface of many types of cells. The occurrence and distribution of the HB-EGF receptor on cells determines the susceptibility of an animal species, and certain cells of an animal species, to the diphtheria toxin. Normally, the HB- EGF precursor releases a peptide hormone that influences normal cell growth and differentiation. One hypothesis is that the HB-EGF receptor itself is the protease that nicks the A fragment and reduces the disulfide bridge between it and the B fragment when the A fragment makes its way through the endosomal membrane into the cytoplasm. Immunity to Diphtheria Acquired immunity to diphtheria is due primarily to toxin-neutralizing antibody (antitoxin). Passive immunity in utero is acquired transplacentally and can last at most 1 or 2 years after birth. In areas where diphtheria is endemic and mass immunization is not practiced, most young children are highly susceptible to infection. Probably active immunity can be produced by a mild or inapparent infection in infants who retain some maternal immunity, and in adults infected with strains of low virulence (inapparent infections). Individuals that have fully recovered from diphtheria may continue to harbor the organisms in the throat or nose for weeks or even months. In the past, it was mainly through such healthy carriers that the disease was spread, and toxigenic bacteria were maintained in the population. Before mass immunization of children, carrier rates of C. diphtheriae of 5% or higher were observed. Because of the high degree of susceptibility of children, artificial immunization at an early age is universally advocated. Toxoid is given in 2 or 3 doses (1 month apart) for primary immunization at an age of 3 - 4 months. A booster injection should be given about a year later, and it is advisable to administer several booster injections during childhood. Usually, infants in the United States are immunized with a trivalent vaccine containing diphtheria toxoid, pertussis vaccine, and tetanus toxoid (DPT or DTP vaccine). f:\12000 essays\health & humanities (196)\Down Syndrome Report.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Down Syndrome Report by: SCHOOL SUX The chromosomal abnormality involved in most cases of Down syndrome is trisomy-21, or the presence of three copies of the 21st chromosome. As a result, the affected person has 47 chromosomes in all body cells instead of the normal 46, although how this causes the condition's symptoms is not yet known. Scientists assume that the reason for the abnormal chromosomal assortment is the fertilization of an ovum having 24 chromosomes by a sperm with a normal assortment of 23, but they have also found that the sperm can carry the extra chromosome as well. The abnormal ovum or sperm is derived from a germ cell in which the pair of 21st chromosomes holds together and passes into the same sperm or ovum instead of separating. In the type of Down syndrome called translocation, the extra chromosome 21 material is attached to one of the other chromosomes; when some, but not all, of the body's cells carry an extra chromosome 21, the condition is a type of Down syndrome called mosaicism. Because of the extra chromosome 21, children with Down syndrome often have some characteristic physical features, such as a small head, a flat face, slightly upward slanted eyelids, skin folds at the inner corners of the eyes, small nose and mouth, and small hands and feet. Most of these characteristic do not interfere with the child's functioning, a doctor primarily uses the characteristics for diagnostic purposes. These physical features are variable, and children with Down syndrome are usually more like other children than they are different. Individuals with Down syndrome also often have certain medical conditions such as weak muscles, neurological impairments, heart disease, intestinal abnormalities, poorly functioning thyroid gland, eye abnormalities, hearing problems, and skeletal problems. Almost all children with Down syndrome are mentally retarded, in the mild to moderate range. The degree of mental retardation varies considerably. Through medical treatment the disorders and infections accompanying Down syndrome have no effect on an almost normal life span. The overall incidence of Down syndrome is approximately one in 700 births, but the risk varies with the age of the mother. The incidence of Down syndrome in children born to 25-year-old mothers is approximately 1 in 1200; the risk increases to approximately 1 in 350 for 35-year-olds and approximately 1 in 120 for women older than 40 years. Prenatal tests can be used to detect chromosome abnormality causing Down syndrome. SOURCES 1) "Down Syndrome," Microsoft(R) Encarta(R) 96 Encyclopedia. (c) 1993-1995 Microsoft Corporation. All rights reserved. (c) Funk & Wagnalls Corporation. All rights reserved. 2) "Down Syndrome," Encyclopedia of Sleep and Dreaming. f:\12000 essays\health & humanities (196)\dream problems.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Dreaming problems A large epidemic affecting approximately one in two Americans, according to a Gallup survey, is sleeping difficulty. This difficulty can come in one of many different forms. Problems falling asleep, grogginess after sufficient amounts of sleep, or waking suddenly and not being able to fall back asleep are the most common of the problems that occur in Americans. I shall explain in my report, the importance of sleep, differences in types of sleep, the approximate ³reccomended daily amount² of sleep, variables that may affect sleep, and some simple tips to aide you in attaining effective slumber. Why, exactly is sleep necessary? Sleep is more than a period of rest for the brain, in fact, it is just the opposite. As you sleep, your body repairs itself, and your psyche repairs itself, also. According to the Gallup poll, people who don¹t have problems sleeping, are able to cope with problems easier, concentrate better, and finish tasks more adequitely. Lack of sleep can cause memory, learning, reasoning and calulation functions to decrease in efficiency. Lack of sleep can lead to illness and psychiatric problems also. An approximate 200,000 auto accidents are probably caused by sleep hindrence, and also, an estimate was made that sleep deprivation and work cost the economy one hundred fifty thousand dollars. Amount of sleep necessary depends upon the individual. Some are ready to go with six hours of sleep, while others can¹t function without nine. If a person feels unable to stay focused during monotonous or boring work, it is possible they may need more sleep. Also, need for sleep doesn¹t decline with age, it just may be more difficult to retain the ablility to sleep, as one may lose vision or hearing. Sleep is not just a time of relaxation and rest for the body. In fact, the body is doing as much (almost) when asleep (sometimes) as when awake. There are, in fact, five stages of sleep. They include four stages of relaxation and one of dreaming. The dreaming stage, REM, is one where the body is paralyzed, and the brain is afire with activity. Your mind creates scenarios for you, and has usually four or five per night. Some factors that may affect your sleep are as follows. There are a great many possiblile variables in sleep deprivation, and are usually the cause of insomnia. Stress in the workplace, home, social situation, or anywhere else is the number one cause of sleeping distress. Alcohol or caffiene in the afternoon or evening can severly alter sleep habits. Physical or mentally intense activities can cause sleep deprivation or difficulty also. Workers on shifts are shown to be two to five times more likely to fall asleep on the job than regular hours workers. External factors like sounds, smells, or discomfortable variables in a sleep environment can hinder sleep. Arthritis or other biological conditions or problems fall in the last category. Certain medicines and steroids can cause sleeping problems as side effects from their designated purpose. Anyone exposed to any of the above factors can be at risk to sleep deprivation. Basically, anyone can fall victim to sleep In any case of sleep deprivation, If a problem persists, it is best to consult a physician. Try to use some of the following easy techinques for possibile eradication of sleep deprivation. If you cannot remove it with the simple suggestions below, or cannot do it quicly, it is best to consult a physician. €Avoid caffeine, nicotine and alcohol in the late afternoon and evening. €Exercise regularly, but do so at least three hours before bedtime. €If you have trouble sleeping when you go to bed, don't nap during the day €Establish a regular, relaxing bedtime routine that will allow you to unwind and send a "signal" to your brain that it's time to sleep. €Don't use your bed for anything other than sleep or sex. €If you can't go to sleep after 30 minutes, don't stay in bed tossing and turning. Get up and involve yourself in a relaxing activity, such as listening to soothing music or reading, until you feel sleepy. all information recieved from the internet at: http://www.outsidein.co.uk/ f:\12000 essays\health & humanities (196)\Dreams.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ DREAMS Theories attempting to explain the origin and functions of REM sleep include: (1) that REM sleep provides stimulation for the development of the brain; (2) that it performs a chemical restoration function, since during REM dreaming neuro-protein synthesis occurs along with the restoration of other depleted brain chemicals; (3) that it provides oculomotor (eye movement) coordination, since during non-REM sleep the eyes move independently of each other; (4) that it provides a vigilance function, since REM sleep (stage I) is characterized by a level of consciousness close to the awakened state; (5) in a more recent and controversial theory, REM dreaming performs a neurological erasure function, eliminating extraneous information build-up in the memory system; and (6) that, in a more cognitive psychological explanation, REM dreaming enhances memory storage and reorganization. Contrary to popular belief, dreaming is not caused by eating certain foods before bedtime, nor by environmental stimuli during sleeping. Dreaming is caused by internal biological process. Some researchers have proposed the activation-synthesis hypothesis. Their neurological research indicates that large brain cells in the primitive brain stem spontaneously fire about every 90 minutes, sending random stimuli to cortical areas of the BRAIN. As a consequence, memory, sensory, muscle-control, and cognitive areas of the brain are randomly stimulated, resulting in the higher cortical brain attempting to make some sense of it. This, according to the research, gives rise to the experience of a dream. Now, as in the past, the most significant controversy centers on the question of whether dreams have intentional, or actual personal, meaning. Many psychotherapists maintain that while the neurological impulses from the brain stem may activate the dreaming process, the content or meaningful representations in dreams are caused by nonconscious needs, wishes, desires, and everyday concerns of the dreamer. Thus, such psychotherapists subscribe to the phenomenological-clinical, or "top-down," explanation, which holds that dreams are intentionally meaningful messages from the unconscious. The neurological, or "bottom-up," explanation maintains that dreams have no intentional meaning. In between these two positions is an approach called content analysis. Content analysis simply describes and classifies the various representations in dreams, such as people, houses, cars, trees, animals, and color, though no deep interpretation is attributed to the content. Differences in content have been discovered between the dreams of males and females, and between dreams and occurring in different developmental stages of life. What these differences mean is under investigation. Some recent research seems to indicate that dream content reflects problems that the dreamer experiences in life, and that the function of such dreams is to facilitate the emotional resolution of the problems. Numerous accounts exist of scientific problems being resolved, and literary works being developed in dreams after dreamers had consciously immersed themselves in a problem for an extended time. Cognitive psychologists are concerned with logic and thought processing during dreaming, and how they are different from mental processes during the waking state. In studies of the developmental cognitive processes of children's dreams, for instance, it has been found that the increasing complexity of children's dreams parallel waking cognitive development. Many researchers believe that knowledge about dreaming is important for understanding waking imagination. Current and future research issues involve further establishing and extending all of the above areas. Anthropologists are studying cross-culture similarities and differences in dreams. Research into NIGHTMARES and bizarre dreams continues. In addition, REM research is important for understanding psychobiological abnormalities. Some findings indicate that epileptic seizures are suppressed during REM sleep. Narcoleptics, people who may involuntarily fall asleep at any time, enter REM sleep almost immediately. Research continues on the variations in dream recall. For instance, artists tend to recall more dreams than scientists, and, for the population at large, only a small percentage of dreams are recalled. Lucid dreaming, the ability of dreamers to become aware of and to control their dreams while dreaming, is also the focus of some current research. Some lucid dreamers can learn to communicate with researchers through nonverbal signals. New research also promises to yield significant knowledge about memory, storage and retrieval, cognitive organization, psychobiological processes, human consciousness, and specific operations of the mind f:\12000 essays\health & humanities (196)\drinking and driving offenses.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ "DRINKING AND DRIVING OFFENCES" My essay is on "Drinking and Driving Offences". In my essay I will tell you the various kinds of drinking and driving offences, the penalties,and the defences you can make if you are caught drinking and driving. Let me tell you about the different offences. There are six offences in drinking and driving. They are "driving while impaired", "Having care and control of a vehicle while impaired", "Driving while exceeding 80 m.g.", "Having care and control of a vehicle while exceeding 80 m.g.", "Refusing to give a breath sample", and "refusing to submit to a roadside screen test. These are all Criminal Code Offences. Now lets talk about the penalties of drinking and driving. The sentence for "refusing to give a breath sample" is usually higher than either of the "exceeding 80 m.g." offences. Consequently it is usually easier in the long run for you to give a breath sample if asked. If, for example you are convicted of "Refusing ato give a breath sample" for the first time, but was earlier convicted of "Driving while impaired", your conviction for "Refusing" will count as a second conviction, not a first,and will receive the stiffer penalty for second offences. For the first offence here is the penalty and the defences you can make. Driving a vehicle while your ability to drive is impaired by alcohol or drugs is one of the offences. Evidence of your condition can be used to convict you. This can include evidence of your general conduct, speech, ability to walk a straight line or pick up objects. The penalty of the first offences is a fine of $50.00 to $2000.00 and/or imprisonment of up to six months, and automatic suspension of licence for 3 months. The second offence penalty is imprisonment for 14 days to 1 year and automatic suspension of licence for 6 months. The third offence penalty is imprisonment 2 or 3 months to 2 years (or more) and automatic suspension of licence for six months. These penalties are the same for the following offences. "Having Care and Control of a Motor Vehicle while Impaired" is another offence. Having care and control of a vehicle does not require that you be driving it. Occupying the driver's seat, even if you did not have the keys, is sufficient. Walking towards the car with the keys could be suffi- cient. Some defences are you were not impaired, or you did not have care and control because you were not in the driver's seat, did not have the keys,etc. It is not a defence that you registered below 80 m.g. on the breath- ayzer test. Having care and control depends on all circumstances. "Driving While Exceeding 80 m.g. is the next offence. Driving a vehicle, having consumed alcohol in such a quantity that the proportion of alcohol in your blood exceeds 80 miligrams of alcohol in 100 mililitres of blood. Some defences are the test was administered improperly, or f:\12000 essays\health & humanities (196)\Dyslexia.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ DYSLEXIA General information Imagine if my report was written like this: Dyslexia is wehn yuor midn gets wodrs mixde pu. If you were dyslexic, that's how you might read my report. The word dyslexia is derived from the Greek "dys" (meaning poor or inadequate) and "lexis" (word or language). Dyslexia is a learning disability characterized by problems in expressive or receptive, oral or written language. It is characterized by extreme difficulty learning and remembering letters, written or spoken words, and individual letter sounds. Extremely poor spelling and illegible handwriting are common symptoms. Problems may emerge in reading, spelling, writing, speaking, or listening. Dyslexia is not a disease, therefore it doesn't have a cure. Dyslexia describes a different kind of mind, often gifted and productive, that learns differently. During my extensive research of this topic, I have become very interested and sympathetic for people who have it. Dyslexia is not the result of low intelligence. The problem is not behavioral, psychological, motivational, or social. It is not a problem of vision; people with dyslexia do not "see backward." Dyslexia results from the differences in the structure and function of the brain. People with dyslexia are unique; each having individual strengths and weaknesses. Many dyslexics are creative and have unusual talent in areas such as art, athletics, architecture, graphics, electronics, mechanics, drama, music, or engineering. Dyslexics often show special talent in areas that require visual, spatial, and motor skills. Their problems in language processing distinguish them as a group. This means that the dyslexic has problems translating language to thought (as listening or reading) or thought to language (as in writing or speaking). Dyslexics sometimes reverse letters and words (b for d, saw for was). In speech, some dyslexics reverse meanings (hot for cold, front seat for back seat) or word sounds (merove for remove). Here is a test to see if you have any signs of dyslexia. Few dyslexics show all the signs of the disorder. Here are some of the most common signs: * Lack of awareness of sounds in words, sound order, rhymes, or sequence syllables * Difficulty decoding words - single word identification * Difficulty encoding words - spelling * Poor sequencing of numbers, of letters in words, when read or written, e.g.; b-d; sing - sign; left - felt; soiled - solid; 12-21 * Problems with reading comprehension * Difficulty expressing thought in written form * Delayed spoken language * Imprecise or incomplete interpretation of language that is heard * Difficulty in expressing thoughts orally * Confusion about directions in space or time (right and left, up and down, early and late, yesterday and tomorrow, months and days) * Confusion about right or left handedness * Similar problems among relatives * Difficulty in mathematics - often related to sequencing of steps or directionality or the language of mathematics Who has dyslexia? The National Institute of Health estimates that approximately 15% of the U.S. population is affected by learning disabilities. Of the students with learning disabilities who receive special education services, 80-85% have their basic deficits in language and reading. Every year, 120,000 additional students are found to have learning disabilities, a diagnosis now shared by 2.4 million U.S. school children. Many children are never properly diagnosed or treated, or "fall through the cracks" because they are not deemed eligible for services. Dyslexia occurs among all groups, regardless of age, race, or income. Well-known dyslexics who learned to cope include Nelson Rockefeller, Albert Einstein, Thomas Edison, and Winston Churchill, . At Harvard, dyslexics are allowed to take their examinations on a typewriter, which for some reason significantly helps their scores. Recently, national attention was drawn to Ennis Cosby (son of Bill Cosby), who was also dyslexic. His father ( Bill Cosby) remembers watching in frustration as his son studied and studied but got nowhere with his grades. Ennis managed to enter Morehouse College in Atlanta, but he continued to struggle with his schoolwork. His mother Camille told Jet Magazine in 1992, "We didn't know that Ennis was dyslexic until he went to college." However, Ennis enrolled in a short program that quickly prepared him to deal with his dyslexia and to fully master reading. Soon after he made the dean's list. He then headed for graduate school in New York City to become a teacher of children with learning disabilities. Ennis was also a good singer and actor and shortly before he was killed, he promised a photo shoot with Fila. Many successful people are dyslexic and many dyslexic people are successful. Recent research has established that dyslexia can run in families. A parent, brother, sister, aunt, or grandparent may have had similar learning difficulties. One consistent fact is that 80% of dyslexics are male. Scientists believe the answer to this mystery can be found in the chromosomes. They believe, however, it is possible that dyslexia is caused by a defect on Chromosome 15. What can be done? There are several ways to discover and successfully cope with a learning disability such as dyslexia. One method is to have the dyslexic person take a visual examination by a behavioral optometrist. Here is how one person learned to cope with dyslexia: A man that was examined had problems in eye tracking. He couldn't follow a line across a page smoothly, and his eyes were operating independently. Extensive vision therapy was begun. He came to the offices two and three times a week. No special reading training was suggested. Within a year he was reading at three or more years above his class level. His grades jumped from low scores to the top of the class. He was pleased with himself academically, and no longer found it necessary to walk out of class when he was agitated - in other words, he didn't get that upset anymore. Dyslexia is easier to prevent than to cure. Individuals with dyslexia need special programs to learn to read, write, and spell. Traditional educational programs are not always effective. Individuals with dyslexia require a structured language program. Dyslexia does not usually go away of its own accord, and it can follow otherwise a bright individual. Societies can provide referrals for testers, tutors, and schools specializing in dyslexia, as well as information on new technologies, Individualized Education Programs (IEPs), Individuals with Disabilities Education Act (I.D.E.A.) legislation, Americans with Disabilities Act accommodations for college students and adults, and medical research updates. They encourage early intervention, including a multisensory, structured, sequential approach to language acquisition for individuals with dyslexia. They offer professionals and educators information on multisensory structured language approaches to teaching individuals with dyslexia. f:\12000 essays\health & humanities (196)\Eating Disorders Anorexia.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Eating Disorders: Anorexia Each year millions of people in the United States are affected by serious and sometimes life-threatening eating disorders. The vast majority are adolescents and young adult women. Approximately one percent of adolescents girls develop anorexia nervosa, a dangerous condition in which they can literally starve themselves to death. Another two to three percent develop bulimia nervosa, a destructive pattern of excessive overeating followed by vomiting or other " purging " behaviors to control their weight. These eating disorders also occur in men and older women , but much less frequently. The consequences of eating disorders can be severe. For example, one in ten anorexia nervosa leads to death from starvation, cardiac arrest, or suicide. Fortunately, increasing awareness of the dangers of eating disorders, sparked by medicall studies and extensive media coverage, has led many poeple to seek help. Nevertheless, some people with eating disorders refuse to admit that they have a problem and do not get treatment. Family and friends can help recognize the problem and encourage the person to seek treatment. Anorexia nervosa is a disorder where people intentionally starve themselves. It usually starts around the time of puberty and involves extreme weight loss. Sometimes they must be hospitalized to prevent starvation because food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals, some even collect recipes and prepare gourmet feasts for family and friends. Loss of monthly menstrual periods is typical in women with this disorder and men with this disorder usually become impotent. People with bulmia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or excersising obsessively. Some use a combination of all these forms of purging. Many individuals with bulimia " binge and purge " in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years. As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, do not seek help until they reach their thirties or forties. By then, their eating behavior is deeply ingrained and more difficult to change. Medical complications can frequently be a result of eating disorders. Individuals with eating disorders who use drugs to stimulate vomiting, may be in considerable danger, as this practice increases the risk of heart failure. In patients with anorexia, starvation can damage vital organs such as the heart and brain. To protect itself, the body shifts into " slow gear ": monthly menstrual periods stop, breathing, pulse and, blood pressure rates drop, and thyroid function slows. Nails and hair become brittle, the skin dries, yellows, and becomes covered with soft hair called lanugo. Excessive thirst and frequent urination may occur. Dehydration contributes to constipation, and reduced body fat leads to lowered body temperature and inability to with stand cold. Mild anemia, swollen joints, reduced muscles mass, and light headedness also commonly occur in anorexia. If the disorder becomes severe, patients may lose calcium from their bones, making them brittle and prone to breakage. Scientists from the National Institute of Mental Health ( NIMH ), have also found that patients suffer from other psychiatric illnesses. They may suffer from anxiety, personality or substance abuse disorders, and many are at a risk for suicide. Obsessive compulsive disorder, an illness characterized by repetitive thoughts and behaviors, can also accompany anorexia. Bulimia nervosa patients- even those of normal weight- can severly damage their bodies by frequet binge eating and purging. In rare instances, binge eating causes the stomach to rupture, purging may result in heart failure due to loss of vital minerlas, such a potassium. Vomiting causes other less deadly, but serios, problems. The acid in vomit wears the outer layer of the teeth and can cause scarring on the backs of hands when fingers are pushed down the throat to induce vomiting. Further the esophagus becomes inflamed and glands near the cheeks become swollen. As in anorexia, bulimia may lead to irregular menstual periods and interest in sex may also diminish. Some individuals with bulimia struggle with addictions, including abuse if drugs and alcohol, and compulsive stealing. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety obsessive compulsive disorder, and other psychiatric illnesses. These problems place them at high risk for suicidal behavior. People who binge eat are usually overweight,so they are prone to medical problems, such as high cholesterol, high blood pressure, and diabetes. Research, from the NIMH scientists, has shown that individuals with binge eating disorder have high rates of co-occuring psychiatric illnesses, especially depression. Eating disorders are most successfuly treated when diagnosed early. Unfortunalty, even when family members confront the ill person about his or her behavior, or physicians make a diagnosis, individuals with eating disorders may deny that they have a problem. Thus, people with anorexia may not receive medical or psychological attention until they have already become dangerously thin and malnourished. People with bulimia are often normal weight and are able to hide their illness from others for years. Eating disorders in males may be overlooked because anorexia and bulimia are relatively rare in boys and men. Consequently, getting and keeping people with these disorders into treatment can be extremely difficult. In any case, it cannot be overemphasized how important treatment is for the people who have these disorders. The longer eating behaviors persist, the more difficult it is to overcome the disorder and its effect on the body. If an eating disorder is suspected, particularly if it involves weight loss, the first step is a complete physical examination to rule out any other illnesses. Once an eating disorder is diagnosed, the clinician must determine whether the patient is in immediate medical danger and requires hospitalization. While most patients can be treated as outpatients, some need hospital care. Conditions warranting hospitilization include excessive and rapid weight loss, serious metabolic disturbances, clinical depression or risk of suicide, severe binge eating and purging, or psychosis. The complex interaction of emotional and physiological problems in eating disorders calls for a comprehensive treatment plan, involving a variety of experts and approaches. Ideally the treatment team includes an internist, a nutritionist, an individual psychotherapist, and a psychopharmacologist. To help those with eating disorders deal with their illness and underlying emotional issues, some form of psychotherapy is usually needed. Group therapy, in which people share their experiences with others, has been especailly effective for individuals with bulimia. NIMH supported scientist, have examined the effectiveness of combining psychotherapy and medications. In a recent study of bulimia, researchers have found that both intensive group therapy and antidepressants medications, combined or alone, benefited patients. In another study of bulimia, the combined use of cognitive behavioral therapy and antidepressant medications was most beneficial. This comibination treatment was particularly effective in preventing relapse once medications were discontinued. For patients with binge eating disorder, cognitive behavioral therapy and antidepressant medications may also prove to be useful. For anorexia, preliminary evidence shows that some antidepressant medications may be effective when combined with other forms of treatment. Fluoxetine has also been useful in treating some patients with binge eating disorder and depression. The efforts of mental health professionals need to be combined with those of other health professionals to obtain the best treatment. Physicians treat any medical complications, and nutritionists advise on diet and eating regimens. The challenge of treating eating diorders is made more difficult by the metabolic changes associated with them. Just to maintain a stable weight, individuals with anorexia may actually have to consume more calories than someone of similar weight and age without an eating disorder. This is important, because consuming calories is exactly what the person with anorexia wishes to avoid, yet must do to regain the weight necessary for recovery. In contrast, some normal weight people with bulimia may gain excess weight if they consume the number of calories required to maintain normal weight in others of similar size and age. Treatment can save the life of someone with an eating disorder. Friends, relatives, teachers, and physicians all play an important role in helping the ill person start with a treatment program. Encouragemnt, caring, and persistence, as well as information about eating disorders and their dangers, may be needed to convince the ill person to get help, stick with treatment, or try again. Family members and friends can call local hospitals or university medical centers to find out about eating disorder clinics and clinicians experienced in treating the illnesses, for the college students, treatment progams may be available in school counseling centers. Family and friends should read as mush as possible about eating disorders, so they can help the person with the illness understand his or her problem. Many local mental health organizations and the self help groups provide free literature on eating disorders. Some of these groups also provide treatment program referrals and information on local self help groups. Once the person gets help, he or she will continue to needs lots of understanding and encouragement to stay in treatment. NIMH continues its search for new and better treatments for eating disorders. Congress has designated the 1990's as the " Decade of the Brain, " making the prevention, diagnosis, and treatment of all brain and mental disorders a national research priority. This research promises to yield even more hope for patients and their families by providing a greater understanding of the causes and complexities of eating disorders. f:\12000 essays\health & humanities (196)\Ebola Virus.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Ebola hemorrahagic fever is a 20 year old virus that, with a mortality rate of 50% to 90%, is one of the world's deadliest viruses. Its causative organism is called Ebola virus. Ebola virus is a member of filoviridae, a family of negative-strained RNA viruses. The filoviridae family consists of five known members, Marburg, Ebola Zaire, Ebola Sudan, Ebola Reston, and Ebola Tai. Ebola virus is spread in a number of ways. An outbreak starts when an infected animal or insect, called a vector, transmits the virus to a human. Scientists know that monkeys are both a vector and victim of Ebola, but other vectors are unknown. The natural reservoir for the virus, or organism that is immune to it and carries it is also unknown. A search for the reservoir will take a long time because there are so many possibilities, since Africa is in the tropics. Another way that humans can get Ebola is by eating an infected animal or drinking the milk of an infected animal. Ebola is spread from human to human by contact with infected blood, infected body fluids, or through sexual contact. Even after a person recovers completely from Ebola, it may stay in the semen for up to seven weeks. In the African outbreaks it has also been transmitted by the reuse of needles because the health care systems are so under financed. Ebola wasn't thought to be an airborne virus, but recent studies by the US Army Medical Research Institute of Infectious Diseases and the CDC found that monkeys showed Ebola like symptoms after being exposed to aerosolized Ebola. The studies also found that the virus is many times present in the respiratory systems of Ebola victims. Although the 1989 outbreak in Reston, Virginia wasn't harmful to humans, it was found that droplet and vomit transmission played a major role in spreading the disease through the quarantine facility. The onset of the Ebola virus is very quick. The incubation period ranges anywhere from two days to twenty-one days. After signs of the virus appear, the victim can die within days, or at the most, a week. There are a few stages after being infected with the virus. The symptoms of the first stage include headaches, fever, muscle pain, fatigue, chills, and loss of appetite. The second stage consists of vomiting, diarrhea, abdominal pain, sore throat, and chest pain. The last stages are very ugly. They consist of severe clotting and hemorrhaging. The clots form throughout the body and shut of blood to many organs, especially the brain, liver, and spleen. These organs that don't receive blood begin to decay. Blood leaks into tissues, fills internal cavities, and stops clotting. Blood leaks through the skin and all other openings. The skin becomes very easily ripped and the victim can bleed profusely just by being touched. Then the body's connective tissues lose their stretchiness and become very spongy. Hemorrhages and blood clots in the brain cause the person's face to become expressionless and frozen. The Ebola virus spreads to all fluids in the body and the victim eventually dies from blood loss and shock. When the victim dies all that is left is a decayed body filled with virus particles. Ebola virus is diagnosed in only one way. It is diagnosed in specialized laboratory tests on blood specimens. These tests look for Ebola antigens, antibodies, or the isolated virus in the specimens. Since the virus is so deadly, these diagnostic tests are an extreme biohazard and are performed only with extreme caution. The Ebola virus is the world's third deadliest infectious disease, behind HIV, and rabies, which has a vaccine. The only treatment that can be given to Ebola victims is support. They are usually very dehydrated and need management of fluid and electrolyte balance. Victims may sometimes require IV feeds to replace liquids. Before shock occurs it may be helpful to replace plasma albumin. There is currently no cure or vaccine for the Ebola virus., although it is recorded that someone in the United Kingdom was infected with Ebola Zaire and was injected with the plasma of a recovered Ebola Zaire victim and recovered fully. The opposite was also shown when recovered Ebola Reston monkeys were infected with Ebola Zaire and died faster than monkeys infected with just the Ebola Zaire strain. Therefore, it is thought that plasma injections only work on common strain victims. The first occurrence of the Ebola virus was discovered in July of 1979 near the Ebola River in Northern Zaire after a worker in a cotton factory in Nzara, Sudan became very ill. Later that year a similar virus spread through more than 50 villages along the river in Zaire. This outbreak caused about 500 deaths. Scientists from the CDC in Atlanta named the new virus Ebola, subtype Zaire. The virus that caused the outbreak in Sudan was later called Ebola Sudan. In 1977 a child in Tandala, Zaire died of a hemorrahagic fever. In 1977 another outbreak occurred in Sudan and the first case was pinpointed to the same room in the cotton factory that the victim in 1979 had worked in. In 1989 another strain of Ebola was found in Reston, Virginia. This strain was named Ebola Reston. This outbreak was traced to monkeys that had been imported from the Philippines. The monkeys infected four humans, but this strain of Ebola was found only to give humans flu-like symptoms. From January through August of 1995 there was a major outbreak in and around Kikwit, Zaire. In this outbreak there was a mortality rate of 77%, with 315 cases and 244 deaths. In May of 1995 the city was put under quarantine and troops monitored it. On July 14, 1995 the last reported victim of Ebola was discharged from the hospital. Health officials waited twice the maximum incubation period and on August 24, 1995, 42 days after the last reported victim recovered, the outbreak was declared over and the quarantine was lifted. On December 19, 1995 a small Ebola scare in the Cote d'Ivoire/Liberia border region was declared over. In this small outbreak only one person was infected, but he survived. Mr. Jasper Chea was infected with the virus while dissecting a dead monkey. He recovered in a local hospital. This new strain of Ebola was called Ebola Tai. The most recent Ebola outbreak was officially declared over after two incubation periods without any other new cases on April 23, 1996. This outbreak of the disease occurred in Gabon, Africa. This outbreak resulted in 21 deaths out of 37 cases, a 57% fatality rate. An interesting side-note to the history of Ebola is that from 430-425 BC a deadly plague killed 300,000 in Athens. Scientists from the CDC suggest that this ancient plague was actually Ebola. Scientists found many similarities between this plague and the recent Sudan and Zaire outbreaks. They also found paintings on Greek islands near Athens that have pictures of green monkeys. This theory is questioned by Kevin DeCock, of the London School of Hygiene and Tropical Medicine because he says that "one of the main symptoms of Ebola is copious quantities of blood, which does not feature in Thucydide's (ancient Athenian who recorded the plague) account." Since Ebola is still an active virus and there is no cure or vaccine there is a lot of research being done. Most of the research focuses around pinpointing the reservoir organism. Two major institutions are taking up this research, the WHO and the CDC. The CDC is starting this research by collecting animals and insects to experiment with. The WHO is looking for the reservoir in Cote d'Ivoire. In Cote d'Ivoire the chimpanzees get infected with Ebola every other Autumn, but there has never been enough money to research this. The WHO is doing this research and raising money to do other research on Ebola. There is also research for a possible cure or vaccine. f:\12000 essays\health & humanities (196)\Environmental Tobacco Smoke.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Mark Ritter Matt Porter Research Paper November 25, 1996 ENVIRONMENTAL TOBACCO SMOKE Tobacco smoking has long been recognized as a major cause of death and disease, responsible for an estimated 434,000 deaths per year in the United States. After the Environmental Protection Agency and the Surgeon General stated that cigarettes cause lung cancer there was a tremendous movement to make cigarettes illegal. Now the debate is on environmental tobacco smoke also known as secondhand smoke, passive smoking, and sidestream smoke. The worry is that when non-smokers are exposed to secondhand smoke they face the same health hazards as smokers. Tobacco smoke contains more than forty known carcinogens. Sidestream smoke carries these carcinogens into the air (Sussman 12). According to scientific studies tobacco smoke contains four thousand chemicals, and at least sixty are known to cause cancer. Carbon monoxide is the main gas in cigarette smoke. This gas competes with oxygen for binding sites on red blood cells, and results in depleting the body of oxygen (Q&A). Researchers studied 1,906 women of which 653 developed lung cancer. Women married to smokers were thirty percent more likely to develop lung cancer than those married to non-smokers (LeMaistre 1). According to the Environmental Protection Agency a thirty percent risk is only a small relative risk. The Environmental Protection Agency released its report stating that environmental tobacco smoke is a human lung carcinogen, responsible for approximately three thousand lung cancer deaths annually in American non-smokers. Environmental tobacco smoke has been classified as a Group A carcinogen, the highest ranking under the EPA's carcinogen assessment guidelines. f:\12000 essays\health & humanities (196)\Epidemiology of Varsity Sports.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Epidemiology of Varsity Sports Varsity sports is in many schools as important as academics, especially in the United States. These schools rely a great deal on the success of their teams for financial stability and enrollment interest. The athletes as well take their sport very seriously, if only for the sake of their pride. It therefore follows that each team strives to be the very best, and only 100% effort is enough. Unfortunately, when competition climaxes, more often than not injuries result. This study is a synopsis of the data collected in a number of past articles concerned with injuries incurred by collegiate athletes in many different varsity sports. For the purpose of this study, an injury has been defined as any abnormal condition that has caused an athlete to be removed from practice or competition for one or more days, because performance has been impaired (Hanes and Murray, 1982). The following statistics will deal with injuries of collegiate sports incurred by athletes involved in Men's and Women's Basketball, Baseball, Gymnastics and Track and Field, Men's Soccer, and Wrestling, and Women's Field Hockey. BASKETBALL The study of the nature and extent of athletic injuries Occuring in Women's Basketball by Hanes and Murray in 1982 found an injury rate of 41.7 per 100 players. Of these injuries 56.9% were ankle sprains, 24.1% were muscle strains. 76.2% of the sprains and strains occurred to the lower extremities. Injured fingers ( which were the only upper extremity injuries) accounted for 14.3% of the injuries and 4.8% of the injuries were reported as facial. All information for this study was collected through the use of injury forms completed by the coaches, and information forms by each player, injured or not. In a separate study for the American Journal of Sports Medicine by Clarke and Buckley in 1980 on injuries incurred in collegiate Women's Basketball, there was an injury rate of 20.3 per 100 players. There was a reported incidence of 53% sprains, and 4% strains. 40% of all injuries sustained were to the lower extremities. In the same study Clarke and Buckley found similar results in Men's Varsity Basketball to that of the Women's. The men reported 20.7 per 100 players suffering injuries, 54% of those being sprains, 6% being strains with 37% of the injuries Occuring to the lower extremity. All the data collected by Clarke and Buckley was received from the National Athletic Injury/ Illness Recording System (NAIRS). BASEBALL Clark and Buckley have also examined Men's and Women's Baseball in their study The reported injury rate for this particular sport was 9.2% (men's) and 8.7% (women's). Sprains occurred 37% and 40% respectively, strains accounted for 28% and 12%. Men's baseball saw 69% of the injuries in the lower extremity, women's baseball reported 82% of the injuries in the lower extremities. FIELD HOCKEY Women's Field hockey had a similarly low injury rate according to Clarke and Buckley, at only 5.5%. Sprains once again were the most common injury, comprising 37% of the incidence rate, and strains made up 21%. As might be expected by the nature of the sport, the lower extremities received 72% of the injuries. TRACK AND FIELD The incidence rate of the Men's and Women's Track and Field teams were 10% and 12% respectively. Although as Clarke and Buckley found, this sport alone saw different injuries come to the forefront. It was muscle strains that seemed most prevalent, Occuring 48% (men's) and 26% (women's) of the time. Sprains accounted for only 18% and 16% of the injuries. But as would seem fitting the men were inflicted with 72% of the injuries to the lower extremities, and the women 92%. WRESTLING After a five-year study of two University wrestling teams, Snook (1982) found wrestling to have the highest incidence of injury of all those examined in this article, with an injury rate of 35.7 per 100 participants. The type of injury was fairly evenly divided between sprains (31.03%) and strains (27.58%) as it was between injuries to the upper (43%) and lower extremities (55%). SOCCER As should be expected, Men's soccer saw a very high incidence of injury to the lower extremities. According to Davis (1977) 85.02% of all injuries occurred to the legs and ankles, with sprains comprising 31.03% and strains comprising 27.58%. There was an overall injury rate of 33.21 per 100 players for his study. Clarke and Buckley similarly found that 76% of the injuries (an overall rate of 13.2%) occurred to the lower limbs, with 49% of those being sprains, and 12% strains. GYMNASTICS According to Clarke and Buckley, Women's Gymnastics followed only Wrestling in amount of injuries. With an incidence rate of 28.4%, Gymnastics is one of the most dangerous sports in varsity athletics (within the scope of this study). 66% of the injuries were sprains and 17% were strains. Of the overall injury rate 67% occurred to the lower extremity. In contrast, Garrick and Requa found that sprains accounted for only 24% of the overall injury rate of 39%, while strains comprised 47%. Both however, were consistent in their findings of injury to the lower extremity (67% and 60% respectively). COMMENT It becomes evident as the statistics are revealed throughout this article that it is very difficult to compare such a wide variety of sports from an epidemiological point of view. The differences between each in the potential injuries, mechanisms of injury and type of athlete typically suited for any given sport make it inappropriate to attempt to draw lines of comparison between them. If one were to look at the athlete playing for the Men's Baseball team and an athlete with the Men's Wrestling team, the differences in physical characteristics alone would make it hard to draw any feasible conclusions pertaining to causation, trends, or even with respect to methods of rehabilitation simply because of the drastic differences in conditioning programs, training methods, and intensity of competition. This argument becomes even more pertinent when one begins to look at incidence rates of those injuries incurred in each sport which have thus far not been mentioned in this article, such as head, neck and spine injury, or something less drastic such as knee injuries. As Snook cites in his article, head, neck and spine injuries account for 12% of the overall incidence rate in wrestling. The nature of the sport predisposes the athlete to a greater risk of such an injury. When this is compared to baseball, whose incidence of head , neck and spine injury accounts for only 2% of the overall injuries it becomes apparent wherein the problems occur. Similarly this may be further illustrated by comparing the incidence of knee injuries between the two( 7% in baseball and 25.7% in wrestling). Problems can even arise when comparing Men's and Women's teams of the same sport, simply because differences in physical characteristics of men and women. If we are to look to baseball once again, the incidence of knee injuries to men is reported in Clarke and Buckley's article as 7%, while knee injuries to women account for 19%. Large differences can also be observed in the incidence of fractures in male (7%) and female (25%) baseball players. On the other hand, while a study such as this may be inappropriate for comparison, it does allow one to observe the potential hazards of many different sports and perhaps encourage those participating in such athletics to develop or improve on a conditioning program for a given sport, in order to minimize the risk that any such misfortune may occur. BIBLIOGRAPHY Clarke, E. & Buckley, J. "Women's Injuries in Collegiate Sports". American Journal of Sports Medicine. Vol. 8, No. 3 (1980). pp188-93. Davis, Michael Stewart. "The Nature and Incidence of Injuries to the Lower Extremity of College Soccer Players".Mar, 1977. Hanes, A. & Murray, C. "Athletic Injuries Occuring in Women's Highschool Basketball". Sept, 1982. Garrick, James G. "Women's Gymnastics Injuries".American Journal of Sports Medicine. Vol. 7, No. 4 (1979).pp. 261-64. Snook, George A. "Injuries in Intercollegiate Wrestling".American Journal of Sports Medicine. Vol.10, No. 3 (1982).pp. 141-43. Snook, George A. "Injuries in Women's Gymnastics".American Journal of Sports Injuries.Vol. 7, No. 4 (1979) pp.242-45. f:\12000 essays\health & humanities (196)\Ethical Dilemna.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Jim Polak Group #3 Ethical Problem 4/1/96 During my high school years, I had to make many decisions. Some of these decisions came easily to me, like what clothes to wear to school. Some of them took more thought, like what classes I should take during the upcoming semester. And some of them were questions that kept me up all night to decide between right and wrong and forcing me to determine what would be in my best interest. At this time, I was thinking as a Consequentialist. Personal ethical egoism thinks that I always ought to act in my self-interest. One of the hardest decisions I ever had to make involved whether or not I would drink alcohol. This question kept me pondering off and on for the better part of three school years and the second semester of my first college year. If I just considered the legal side of things, then this should have been an easy decision for me because of the fact that I was under age and it is obviously illegal for persons who have not yet turned twenty-one to consume alcoholic beverages. This would be the fifth stage of moral functioning, Legality. If you think at this stage, you will follow the rules and laws all the time. The law, however, did not prevent many of my friends from drinking nor did it do much in the way of stopping them after they had started. The law was too easy to avoid so getting caught by the cops was rarely a matter of great concern. Besides, even when one of my friends would get caught, they were usually released to their parents with nothing more than a stern warning from the officer who gave them the ride home. Now, being at home brings up another reason not to drink. We all want to try to obey our parents, right! Well actually, I did, want to try that is. This stage of moral functioning is called Conformity. Here you try to be good boys and girls. I wasn't going to be able to please them all the time, but I did want to try. My home life was a lot easier if Dad and Mom weren't on my case all the time. I had already spent most of my freshmen year of high school at home because of disobeying my parents. This meant that in order for me to have any sort of social life, I had to watch my step so that I wasn't grounded during the next big social engagement. That meant that if I was going to drink with my friends, I could never get caught, because getting caught could leave me seeing my friends only during classes. Another factor wrestling with my mind was the fact that I had tried a beer or two before to see what would happen, and all I had found was that I really don't like the taste. I couldn't see how drinking something that tasted so awful could make people feel so good. I was also out for sports, so getting caught drinking alcohol could have lead to suspension from a few meets or even being kicked off the team. If I was on school grounds, I could also get suspended from school which could affect my grades and also my chances of getting the big scholarship to college I wanted. So, finally after considering all of these possibilities, it occurred to me that there was truly only one decision for me to make at this point in my life--not to drink yet. Use of Legality and Conformity, helped me decide not to drink yet. I would say that I'm more of a relativist than an absolutist because my actions would depend on the situation. I didn't decide that it would be unethical for me if I drank later in life, but during high school it had many more downs than ups. I would still have Individual Freedom to make a different choice latter in my life. f:\12000 essays\health & humanities (196)\Ethical Values.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ There are so many various types of people with different ethnic backgrounds, culture and manner of living that are the cause of distinct values in a family. These families have poor, mediocre or virtuous family values, however what one may consider as a mediocre family value may seem poor to someone else and vice-versa. These family values differ from family to family world-wide. The most significant values are family unity, honesty and education. Family unity, is a family being together in blissful harmony on holidays. Family unity is regardless how bad a situation may be it will bring us closer together and make our bond stronger. Family unity is my family watching me grow from infancy to adulthood, guiding me with good values. Family unity is communicating with each other. Unfortunately, my parents were seldom around during my childhood stages. Therefore they were rarely home to guide me through good family values. Now that I am an adult my parents are persistent to spend time with me and teach me values not taught to me when I was a child. I believe it's like teaching an old dog new tricks. A child needs direction from the childhood up to adulthood not the reverse. I recall coming home from school to an empty house. My parents were working to provide us with a home, things we needed and wanted. Regardless, as a child a family was just as important. A popular soul singer, Luther Vandross, sang a song whose lyrics explained about objects in a house that were still the same, but a house was not a home if there wasn't anyone there you can kiss good night. I must agree with Luther, I've felt the same way for years. It would have been nice to have my parents home to enforce rules at home. For example, if someone would have been home I would have done my homework instead of going outside to play. Another example is sitting together as a family to have dinner is something we rarely did. There were many things I wish we would have discussed at the dinner table. Having my parents spend time with me on weekends would have been very good example of family values. My parents were so busy trying to give us everything material and forgot that spending time with us meant more. Secondly, the value of honesty. Honesty is the back bone of a persons word. Without it there would not be any meaning. Throughout my life my father always stressed that honesty was an important value. In other words , "honesty is the best policy." Of course there are times when honesty may hurt someone's feelings, but that was an situation we had to decide on our own. I can even remember my very first honesty lesson my parents taught me. It was taking my grandfathers silver dollars and playing with them when I shouldn't. I later that evening my grandfather went to go show my younger sister those silver dollars and somehow they were missing. My mother and father came to me because earlier that day grandfather showed me those silver dollars and my parent thought I might have taken them to play with. Well, when I was asked that sixty-four thousand dollar "Brian did you take Grandfathers silver dollars" my answer was "no". Well later that day, while I was playing in the play room my father happen to walk in while I was loading those missing silver dollars on to my dump truck. Boy did I know I was in trouble. He crabbed me by the arm and explained to me that it was not nice to lie to them. So dad made me go out to grandfather and apologize to him and my mother and told me it was not right to lie. I will never forget that valuable lesson my father taught me that day. My third most valuable belief is education. Having come from a family with both parents without a college degree. My parents strongly believed that education was a value for future success. They had me observe how they both had to work to make ends meet. Both of them explained however if they had received a college education thing would have been a little easier around the family. They now realize the value of a college education and what it means to the whole family. It would have meant mom could have stayed home with us during younger years and built our values up even more then they are now. That is what they are trying to prevent from happening to me and my family. It is not until now I realize what they were talking about. Just watching the evening news and seeing these families who are less fortunate to go attend college makes me appreciate the chance my parent give me. These are just some of the many values my parents preach to me over the years. Family unity, honesty, and education are the gigantic values that I can remember my parent discussing with me. These three values that were instilled in me will one day be passed on to my children because I feel that these values are very significant in establishing one's self and one's own personal values. f:\12000 essays\health & humanities (196)\Euthanasia is not Murder.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Euthanasia is not Murder Debate continues over the issue of euthanasia because of the recent court decision over Dr. Death. Kevorkian has been aquitted of murder in his assisted suicide cases and the court has created precedent for the legalization of selecting death. Euthanasia does take place and is selected voluntarily by patients who are in great pain due to an incurable illness like cancer. Usually, the decision is made to pull the plugs of machines which prolong life or to end treatment. Because patients select to die, their deaths end suffering, and there is no intention to cause harm, physician assisted euthanasia cannot be considered murder. Murder can be defined as an act of violence which is perpetrated against a victim. For example, a man stuffed into a car after being shot five times is a murder victim. The individual dies at a time which is forced by the killer who has intent to harm him or her. For instance, when the Boston strangler killed the women, he first terrorized them. Frequently murder is painfuland the person who is dying has not voluntarily decided to participate in his or her death. By its nature, murder is death by violence at a time of the killer's rather than nature's choosing. Unlike murder, euthanasia is not an act of violence. In an editorial in the Cleveland Plain Dealer, Dr. Eric Chevlen argues that patients, who are worn down by pain, extensive testing, and depression, will be easily persuaded to seek assisted suicide (11B). Furthermore, Chevlen mentions that the courts have decided that the right to die should be made available to everyone (11B). Modern medical technology has allowed doctors to prolong life past the point of a patient's natural death. In the case of euthanasia, the doctor needs to end suffering from cancer or AIDS and assist the patient to die comfortably. Patients are beginning to assert their right to die rather than being kept alive forcibly. For example, a Texan who suffered burns in a gas explosion, Dan Cowart wanted to die even though he survived the accident. He believes that his rights were violated by the doctors who prevented his death through life-sustaining treatment. When a patient like Cowart is in constant pain, death becomes a peaceful reward. Additionally, doctor assisted euthanasia is performed with the full consent of the patient. Murder steals life, while euthanasia gives the patient release. A patient with a degenerative neurological condition has, in one case, begged ofr help to die. The patients who have been helped by Dr. Kevorkian have all been cancer victims whose daily bouts with pain.....,........ The patients have requested their delivery from life. Muder on the other hand, usually takes the victim by surprise. Another person has, for the most part, decided when the murdered individual will die and by what method, but the slain person has not given permission to be killed. Finally, murders are committed with malice or harmful intent. People are killed to keep secrets, steal power or money, and for other reasons, usually criminal in nature. In other cases, a person is killed out of hatred or because someone has determined that the person belongs to the wrong church, ethnic group, or political affiliation. For example, hate crimes like murdering African Americans, Jews, or other ethnic groups, are done out of an intention to harm these people to get rid of them. Genocide like that done by Hitler was wholesome murder. Like Dr. Kevorkian, other doctors who assist patients in ending their lives help people to end pain and sufferining. Part of the doctor's oath is to offer ease, and those patients, who desire to prevent artificial prolongation of life on machines or stop pain caused by cancer or other terminal diseases, see assisted suicide as a legitimate way out of their personal hell. Opponents to euthanasia see ven assisted suicide as murder. They hold that euthanasia's legalization will give doctors a license to kill. Dr. Chevlen has expressed a fear that patients are "battered by a society whose laws have equated 'terminally ill' with 'worthless'." "He states, "Forse is not necessary in such a situation. Persuasion suffices to convince the patient to choose death. (B11) According to an Internet survey, samples of doctors questioned about euthanasia reported that they did not consult ohter physicians or even falsified the cause of death. Euthanasia opponents claim that doctors have a duty to save lives and should not take a person off a machine, if the machine will maintain life. Furthermore, the opponents to euthanasia see it as murder because some patients, after they are helped, are brain dead and unable to know what is happenening to them . Those who do not see euthanasia as murder counter this claim by saying that the doctors have written consent from a time when the patient was lucid. Additionally, if a person's brain is dead, legally that person is already biologically dead and it is not murder to stop life support. Derek Humphry, founder of the Hemlock Society in 1980, leads the movement for the right to die for those people who believe that they would desire death if they were incapacitated. Those who join the society believe that the government should protect an individual's right to privacy, allowing him or her to die with dignity in a more natural way. In recent years, the U.S. Supreme Court has allowed certain legislation permitting passive euthanasia to be used in cases where the patient was brain dead. Thus, in such cases as that of Karen Anne Quinlan have has historical impact on the medical profession. Quinlan's parents petitioned the courts to stop using a respirator to assist Karen breathe. In 1976, the courts gave the permission parents sought (Spring and Larson 155-156). However, no cases have yet set a precedent for active euthanasia, meaning that legally active euthanasia is still very controversial. Hence, doctors who support active euthanasia and feel morally obligated to help a patient end pain and suffering, will fulfill their duty by assisting that patient to die more comfortably. In such cases, euthanasia cannot be considered as murder. f:\12000 essays\health & humanities (196)\Famine.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Vaccine Essay Children are one of God's best gifts to people, as watching their children grow is one of the best pleasures people enjoy during their life course. For this reason, parents must take good care of their children during their early years, as they are vulnerable to many diseases due to their weak immunity. There are many diseases, infecting children, that may lead to death such as the polio disease. Scientists found a solution to this problem, by injecting a tiny sample of the virus into the child's blood, in order to stimulate the immune system to fight the disease if the child catches it, which is known as vaccination. However, McTaggart contradicts this by pointing out that vaccination problems far outweigh those of going unvaccinated (1). Therefore, there are many questions concerning the safety and effectiveness of vaccines as opposed to those of going unvaccinated. Vaccines can cause complications that are more harmful than those of going unvaccinated or even the disease itself. Professor of epidemiology at the university of Washington, Dr Russell Alexander, points out that the panel set up to determine the risks of vaccination did not compare it to those of being unvaccinated (qtd in Miller 9). This means that the research done by the panel, which proved vaccination risks to be 'too small to count', contains many weaknesses. McTaggart links the appearance of learning disabilities, autism, and hyperactivity to the beginning of the mass vaccination programs (1). Thus, vaccination is directly related to many diseases, in which some are still unknown. McTaggart adds that the mumps vaccine has proved to be a direct cause of seizures, meningitis, deafness, and encephalitis. (6). These are extremely dangerous and unrecoverable diseases. Dr J Anthony Morris, an immunization specialist formerly of America's 'National Institutes of Health' and 'Food and Drug Administration' says that "In several of the studies, the measles vaccine strain has been recovered from the spines of the victims, showing conclusively that the vaccine caused the encephalitis" (qtd in McTaggart. 5). Thus, this doctor as a medical authority relates the measles vaccine to a deadly disease such as the encephalitis. On the other hand, the risks of catching the disease for unvaccinated children are similar, if not less, to the risks of developing harmful complications due to the vaccine. Therefore, vaccination is more risky to your child than going unvaccinated. In addition to the safety problems, vaccines have also proven to be ineffective among many children. McTaggart reasons the current debate about vaccination to the fact that measles portion of the triple shot is not working (2). This means that children who receive the triple shot, called MMR, which is a short hand for measles, mumps, and rubella, are not completely immune against these diseases. McTaggart adds that the cases of measles are increasing exponentially during the last decade (2). Similar to measles, McTaggart states that rubella's portion of the vaccine showed failure in preventing this fatal disease (3). Therefore, the fact that vaccination is not effective is common in many diseases. According to the 'Centers for Disease Control Morbidity and Mortality' in 1985, about 80 percent of measles cases occurring to children in America were in vaccinated ones who were vaccinated in an appropriate age (McTaggart 3). Therefore, generally vaccination is ineffective against most diseases. Vaccine supporters defend vaccines claiming that it caused a reduction in the number of disease cases among children upon its invention. However, this claim is wrong, as it lacks an important side, which is was the number of disease among children increasing or decreasing before the vaccine invention. By reviewing the child disease history before vaccine's invention, we see that the number of child-disease cases was already decreasing before the invention of vaccines. Nowadays, the number of child-disease cases are beginning to grow again due to the increasing use of vaccines. Vaccines are not the reason for the decreasing number of child-disease cases, as it is steadily increasing nowadays. Therefore, vaccinated children face more problems than the unvaccinated ones. Vaccination is hazardous to the child's health and could cause even greater complications than those of the disease itself. In addition to safety problems, vaccination has proved to be ineffective against many diseases such as measles and rubella to name some of them. Besides, Castro infers in "House and Home" magazine, that childhood illness gives the child's immunity a chance to develop stronger and more resistant to diseases (24). Thus, it is a kind of training for the immune system of the child against diseases. Therefore, vaccination should be abolished, for it is not safe nor it is effective against many diseases. Bibliography Castro, Miranda. "Measles, Mumps, Chickenpox, The natural way to nurse them.". House and Home Apr. 1994: 24-25. McTaggart, Lynne. The WDDTY vaccination handbook. Miller, Susan Katz. "Vaccination risks are 'too small to count'. ". New Scientist 25 Sept. 1993: 9. f:\12000 essays\health & humanities (196)\flash memory.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ FLASH MEMORY PSYCHOLOGY TERM PAPER Memory is the main faculty of retaining and recalling past experiences. A repressed memory, is one that is retained in the sub conscious mind, in which one is not aware of it but where it can still affect both conscious thoughts, memory, and behavior. When memory is distorted, the result can be referred to what has been called the "False Memory Syndrome"(Thomas Billing Publishing 1995) : a condition in which a person's identity and interpersonal relationships are entered around a memory of traumatic experience which is obviously false but the person strongly believes that it isn't. However, the syndrome is not only characterized by false memories alone. We all have memories that are inaccurate. Instead, the syndrome may be diagnosed when the memory is so severely disoriented that it changes the individual's entire personality and lifestyle, therefore, disrupting all sorts of other behaviors. The means of personality disorder is on purpose. False memory syndrome is especially destructive because the person carefully avoids any confrontation what so ever with any evidence that might challenge the memory. So this syndrome takes on a life of its own, keeping itself to be alone and resistant to correction. The person may become so focused on the memory that he or she may be effectively distracted from coping with real problems in his or her life. There are many models which try to explain how memory works. Nevertheless, we do not know exactly how memory works. One of the most questionable models of memory is the one which assumes that every experience a person has had is "recorded" in memory and that, "some of these memories are from traumatic events too terrible to want to remember"(Thomas Billings Publishing 1995). . These terrible memories are locked away in the sub conscious mind, (i.e. repressed, only to be remembered in adulthood when some triggering event opens the door to the unconscious). Both before and after the repressed memory is remembered, it causes physical and mental disorders in a person. Some people have made an effort to explain their pain. Even Cancer, was known to form in some through repressed memories of incest in the body. Scientists have studied related phenomenon such as people whose hands bleed in certain religious settings. Presumably such people, called stigmatics, "are not revealing unconscious memories of being crucified as young children, but rather are demonstrating a psychogenic abnormality that springs from their conscious fixation on the suffering of Christ(Copeland Publishing 1989). Similarly, it is possible the idea, that "one was sexually abused might increase the frequency of some physical symptoms, regardless of whether or not the abuse really occurred"(Peter Bedricks Publishing 1994). This view of memory has two elements: (1) the accuracy element and (2) the causal element. The reason why this memory is questionable is not because people don't have unpleasant or painful experiences they would rather forget, nor is it claiming that children often experience both wonderful and brutal things for which they have no right or wrong sense for and are incapable of understanding them, much less relating it to others. It is questionable because, (a) one is having problems of functioning as a healthy human being and (b) one remembers being abused as a child therefore, (A) one was abused as a child and (B) the childhood abuse is the cause of one's adulthood problems. There is no evidence that supports the claim that we remember everything that we experience. In fact, there is plenty of evidence to support the claim that it is impossible for us to even recall to all the elements of any given experience. There is no evidence to support the claim that all memories of experiences happened as they remembered to have happened or that they have even happened at all. We can never even say how accurate our memories really are. Finally, "the connection between abuse and health or behavior does not conclude that ill health, mental pain, is a 'sign' of having been abused."(Peter Bedricks Publishing 1994). However many psychologists don't believe in this theory by the 'False Memory" experts. Here are a few of the unproved, unscientifically researched notions that are being discussed by the doubtful psychologists: "If you doubt that you were abused as a child or think that it might be your imagination, this is a sign of 'post-incest syndrome'. If you can not remember any specific instances of being abused, but still have a feeling that something abusive happened to you, 'it probably did'. When a person can not remember his or her childhood or have very fuzzy memories, 'incest must always be considered as a possibility'. (last), If you have any suspicion at all, if you have any memory, no matter how vague, it probably really happened"(Copeland Publishings 1989). It is said, that it is more likely that you are blocking the memories, denying and that it ever happened. There have been many symptoms that suggest that they were from past abuse. These symptoms range from headaches to irritable bladder. In fact, there was a list of over 900 different symptoms that had been presented as proof of early abuse. When they researched the expert view, they found that not one of the symptoms could be shown to be a solid indication of a previous abuse. Therapists must be careful in declaring that abuse has in fact occurred. Whole industries have been built up to really look into the cases of sexual abuse of children. Therapists who are supposed to help children recover from the trauma of the abuse are hired to interrogate the child, in order to find out if they have been abused. But often the therapist suggests the abuse to the child, has 'memories' of being abused. Increasingly throughout the continent, grown children under going therapeutic programs have come to believe that they suffer from "repressed memories" of incest and sexual abuse. While some reports of incest and sexual abuse are surely true, these delayed memories are too often the result of False Memory Syndrome caused by a disastrous "therapeutic" program(Thomas & Billing Publishing 1995) . False Memory Syndrome has a devastating effect on the victim and produces a continuing dependency on the very program that creates the syndrome. False Memory Syndrome proceeds to destroy the psychological well being not only of the victim but through false accusations of incest and sexual abuse on other members of the victim's family. The dangers of the memory are visible: not only are false memories treated as real memories, but real memories of real abuse may be treated as false memories and may provide real abusers with a believable defense. In the end, no one benefits from a memory which is untrue. Whatever the theory of memory, if it does not support evidence and attempt to verify claims of recollected abuse, it is a theory which will cause more harm than good. Carl Jung, an early Freudian disciple, extended this model of memory, by adding another area of repressed memories to the unconscious mind, an area that was not based on past experiences at all: the "collection unconscious" (Peter Bedricks Publishing 1995). The collective unconscious is the deposit for acts and mental patterns shared either by members of a culture or by all humans. Under certain conditions these become viewed as: images, patterns and symbols, that are often seen in dreams or fantasies and that appear as themes in mythology, religion and fairy tales. Under these conditions it avoids the problem of determining whether or not a memory is accurate by claiming that the memory is not of a personal experience at all. It also confuses several types of mental states. It completely blurs the distinction between dream states and conscious states by eliminating the difference between remembering a sense experience one actually had and remembering a sense experience one never actually had. The story of Hansel and Gretel might be pulled in for "scientific" support of the idea. Assumptions might be made regarding the unconscious desire of all children to be loved by their parents: as children, love could only be understood in terms of ego satisfaction but as adults love is understood primarily in sexual terms. Because of our mental restrictions, we can not bear the thought of wanting to be loved sexually by our parents, so this desire must be expressed in a totally different way: our parents love us sexually. But there is no evidence for this based upon our past or current relationship with our parents, so the mind creates the evidence by remembering being sexually abused as a child.(Copeland Publishings 1989) Thus, the memory we have as adults of being sexually abused by our parents is actually the expression of the desire to be loved by our mother and father (in most cases). It has nothing to do with any real experience; it has everything to do with a human desire. It also serves as a convenient excuse to relieve us of all responsibility for our failures and incompetence. How accurate and reliable is memory? We're often wrong in thinking we accurately remember things. Studies on memory have shown that we often construct our memories from others that help us fill in the gaps in our memories of certain events.(Thomas & Billings Publishing 1995) That is why, for example, a police officer investigating a crime should not show a picture of a single individual to a victim and ask if the victim recognizes the assailant. If the victim is then presented a line up and picks out the individual whose picture the victim had been shown, there is no way of knowing whether the victim is remembering the assailant or the picture. Another interesting fact about memory is that studies have shown that there is no connection between the result feeling a person has about memory and that memory being accurate. Also, opposed to what many believe, hypnosis does not aid memory's accuracy because subjects are unconscience while under hypnosis.(Copeland Publishing 1989) It is possible to create false memories in people's minds by suggestion. Why would someone remember something so horrible if it really did not happen? This is a haunting question, but there are several possible explanations which might shed light on some of the false memories. A pseudomemory, for example, may be a kind of symbolic expression of troubled family relationships. It may be that in such a position people more readily believe things happened when they didn't. When people enter therapy, they do so to get better. They want to change. People also tend to look for some explanation for why they have a problem. Victims come to trust the person they have chosen to help them. Because they are trying to ge f:\12000 essays\health & humanities (196)\Food Preservation.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Throughout the history of mankind science has searched into the realms of the unknown. Along with it bringing new discoveries, allowing for our lives to become healthier, more efficient, safer, and at the same time, possibly more dangerous. Among the forces driving scientists into these many experiments, is the desire to preserve the one fuel that keeps our lives going; FOOD. As early as the beginning of the 19th century, major breakthroughs in food preservation had begun. Soldiers and seamen, fighting in Napoleons army were living off of salt-preserved meats. These poorly cured foods provided minimal nutritional value, and frequent outbreaks of scurvy were developing. It was Napoleon who began the search for a better mechanism of food preservation, and it was he who offered 12,000-franc pieces to the person who devised a safe and dependable food-preservation process. The winner was a French chemist named Nicolas Appert. He observed that food heated in sealed containers was preserved as long as the container remained unopened or the seal did not leak. This became the turning point in food preservation history. Fifty years following the discovery by Nicolas Appert, another breakthrough had developed. Another Frenchman, named Louis Pasteur, noted the relationship between microorganisms and food spoilage. This breakthrough increased the dependability of the food canning process. As the years passed new techniques assuring food preservation would come and go, opening new doors to further research. FOOD PROCESSING Farmers grow fruits and vegetables and fatten livestock. The fruits and vegetables are harvested, and the livestock is slaughtered for food. What happens between the time food leaves the farm and the time it is eaten at the table? Like all living things, the plants and animals that become food contain tiny organisms called microorganisms. Living, healthy plants and animals automatically control most of these microorganisms. But when the plants and animals are killed, the organisms yeast, mold, and bacteria begin to multiply, causing the food to lose flavor and change in color and texture. Just as important, food loses the nutrients that are necessary to build and replenish human bodies. All these changes in the food are what people refer to as food spoilage. To keep the food from spoiling, usually in only a few days, it is preserved. Many kinds of agents are potentially destructive to the healthful characteristics of fresh foods. Microorganisms, such as bacteria and fungi, rapidly spoil food. Enzymes which are present in all raw food, promote degradation and chemical changes affecting especially texture and flavor. Atmospheric oxygen may react with food constituents, causing rancidity or color changes. Equally as harmful are infestations by insects and rodents, which account for tremendous losses in food stocks. There is no single method of food preservation that provides protection against all hazards for an unlimited period of time. Canned food stored in Antarctica near the South Pole, for example, remained edible after 50 years of storage, but such long-term preservation cannot be duplicated in the hot climate of the Tropics. Raw fruits and vegetables and uncooked meat are preserved by cold storage or refrigeration. The cold temperature inside the cold-storage compartment or refrigerator slows down the microorganisms and delays deterioration. But cold storage and refrigeration will preserve raw foods for a few weeks at most. If foods are to be preserved for longer periods, they must undergo special treatments such as freezing or heating. The science of preserving foods for more than a few days is called food processing. Human beings have always taken some measures to preserve food. Ancient people learned to leave meat and fruits and vegetables in the sun and wind to remove moisture. Since microorganisms need water to grow, drying the food slows the rate at which it spoils. Today food processors provide a diet richer and more varied than ever before by using six major methods. They are canning, drying or dehydration, freezing, freeze-drying, fermentation or pickling, and irradiation. Canning The process of canning is sometimes called sterilization because the heat treatment of the food eliminates all microorganisms that can spoil the food and those that are harmful to humans, including directly pathogenic bacteria and those that produce lethal toxins. Most commercial canning operations are based on the principle that bacteria destruction increases tenfold for each 10° C increase in temperature. Food exposed to high temperatures for only minutes or seconds retains more of its natural flavor. In the Flash 18 process, a continuous system, the food is flash-sterilized in a pressurized chamber to prevent the superheated food from boiling while it is placed in containers. Further sterilizing is not required. Freezing Although prehistoric humans stored meat in ice caves, the food-freezing industry is more recent in origin than the canning industry. The freezing process was used commercially for the first time in 1842, but large-scale food preservation by freezing began in the late 19th century with the advent of mechanical refrigeration. Freezing preserves food by preventing microorganisms from multiplying. Because the process does not kill all types of bacteria, however, those that survive reanimate in thawing food and often grow more rapidly than before freezing. Enzymes in the frozen state remain active, although at a reduced rate. Vegetables are blanched or heated in preparation for freezing to ensure enzyme inactivity and thus to avoid degradation of flavor. Blanching has also been proposed for fish, in order to kill cold-adapted bacteria on their outer surface. In the freezing of meats various methods are used depending on the type of meat and the cut. Pork is frozen soon after butchering, but beef is hung in a cooler for several days to tenderize the meat before freezing. Frozen foods have the advantage of resembling the fresh product more closely than the same food preserved by other techniques. Frozen foods also undergo some changes, however. Freezing causes the water in food to expand and tends to disrupt the cell structure by forming ice crystals. In quick-freezing the ice crystals are smaller, producing less cell damage than in the slowly frozen product. The quality of the product, however, may depend more on the rapidity with which the food is prepared and stored in the freezer than on the rate at which it is frozen. Some solid foods that are frozen slowly, such as fish, may, upon thawing, show a loss of liquid called drip; some liquid foods that are frozen slowly, such as egg yolk, may become coagulated. Because of the high cost of refrigeration, frozen food is comparatively expensive to produce and distribute. High quality is a required feature of frozen food to justify the added cost in the market.This method of preservation is the one most widely used for a great variety of foods. Drying and Dehydration Although both these terms are applied to the removal of water from food, to the food technologist drying refers to drying by natural means, such as spreading fruit on racks in the sun, and dehydration designates drying by artificial means, such as a blast of hot air. In freeze-drying a high vacuum is maintained in a special cabinet containing frozen food until most of the moisture has sublimed. Removal of water offers excellent protection against the most common causes of food spoilage. Microorganisms cannot grow in a water-free environment, enzyme activity is absent, and most chemical reactions are greatly retarded. This last characteristic makes dehydration preferable to canning if the product is to be stored at a high temperature. In order to achieve such protection, practically all the water must be removed. The food then must be packaged in a moisture-proof container to prevent it from absorbing water from the air. Vegetables, fruits, meat, fish, and some other foods, the moisture content of which averages as high as 80 percent, may be dried to one-fifth of the original weight and about one-half of the original volume. The disadvantages of this method of preservation include the time and labor involved in rehydrating the food before eating. Further because it absorbs only about two-thirds of its original water content, the dried product tends to have a texture that is tough and chewy. Drying was used by prehistoric humans to preserve many foods. Large quantities of fruits such as figs have been dried from ancient times to the present day. In the case of meat and fish, other preservation methods, such as smoking or salting, which yielded a palatable product, were generally preferred. Commercial dehydration of vegetables was initiated in the United States during the American Civil War but, as a result of the poor quality of the product, the industry declined sharply after the war. This cycle was repeated with subsequent wars, but after World War II the dehydration industry thrived. This industry is confined largely to the production of a few dried foods, however, such as milk, soup, eggs, yeast, and powdered coffee, which are particularly suited to the dehydration method. Present-day dehydration techniques include the application of a stream of warm air to vegetables. Protein foods such as meat are of good quality only if freeze-dried. Liquid food is dehydrated usually by spraying it as fine droplets into a chamber of hot air, or occasionally by pouring it over a drum internally heated by steam. Freeze-drying A processing method that uses a combination of freezing and dehydration is called freeze-drying. Foods that already have been frozen are placed in a vacuum-tight enclosure and dehydrated under vacuum conditions with careful application of heat. Normally ice melts and becomes water when heat is applied. If more heat is applied, it turns to steam. But in freeze-drying, the ice turns directly to vapor, and there is little chance that microorganisms will grow. Freeze-dried foods, like those that are dehydrated, are light and require little space for storage and transportation. They do not need to be refrigerated, but they must be reconstituted with water before they are ready to consume. Irradiation As early as 1895, a major breakthrough in the world of science had arisen; the discovery of the X-ray by German physicist Wilhelm von Roetengen. This technological advancement, along with the soon to be discovered concept of radioactivity by French physicist Antoine Henri Becquerel, became the focus of attention for many scientifically based studies. Of most importance, to the field of food preservation, these two discoveries began the now controversial process of food irradiation. Food irradiation employs an energy form termed ionizing radiation. In short, this process exposes food particles to alpha, beta and/or gamma rays. The rays cause whatever material they strike to produce electrically charged particles called ions. Ionizing radiation provides many attributes to treating foods. It has the ability to penetrate deeply into a food interacting with its atoms and molecules, and causing some chemical and biological effects that could possibly decrease its rate of decay. It also has the ability to sanitize foods by destroying contaminants such as bacteria, yeasts, molds, parasites and insects.Irradiation delays ripening of fruits and vegetables; inhibits sprouting in bulbs and tubers; disinfests grain, cereal products, fresh and dried fruits, and vegetables of insects; and destroys bacteria in fresh meats. The irradiation of fresh fruits and vegetables, herbs and spices, and pork was approved in 1986. In 1990 the FDA approved irradiation of poultry to control salmonella and other disease-causing microorganisms. Irradiated foods were used by U.S. astronauts and by Soviet cosmonauts. Public concern over the safety of irradiation, however, has limited its full-scale use. It is still off to a slow start, with only one food irradiation plant open in Mulberry, Florida, but it is seemingly catching the eyes of the producers and the consumers throughout the world. Miscellaneous Methods Other methods or a combination of methods may be used to preserve foods. Salting of fish and pork has long been practiced, using either dry salt or brine. Salt enters the tissue and, in effect binds the water, thus inhibiting the bacteria that cause spoilage. Another widely used method is smoking, which frequently is applied to preserve fish, ham, and sausage. The smoke is obtained by burning hickory or a similar wood under low draft. In this case some preservative action is provided by such chemicals in the smoke as formaldehyde and creosote, and by the dehydration that occurs in the smokehouse. Smoking usually is intended to flavor the product as well as to preserve it. Sugar, a major ingredient of jams and jellies, is another preservative agent. For effective preservation the total sugar content should make up at least 65 percent of the weight of the final product. Sugar, which acts in much the same way as salt, inhibits bacterial growth after the product has been heated. Because of its high acidity, vinegar (acetic acid) acts as a preservative. Fermentation caused by certain bacteria, which produce lactic acid, is the basis of preservation in sauerkraut and fermented sausage. Sodium benzoate, restricted to concentrations of not more than 0.1 percent, is used in fruit products to protect against yeasts and molds. Sulfur dioxide, another chemical preservative permitted in most states, helps to retain the color of dehydrated foods. Calcium propionate may be added to baked goods to inhibit mold. Packaging The packaging of processed foods is just as important as the process itself. If foods are not packaged in containers that protect them from air and moisture, they are subject to spoilage. Packaging materials must therefore be strong enough to withstand the heat and cold of processing and the wear and tear of handling and transportation. From the time the canning process was developed in the early 19th century until the beginning of the 20th century, cans and glass containers were the only packages used. The first cans were crude containers having a hole in the top through which the food was inserted. The holes were then sealed with hot metal. All cans were made by hand from sheets of metal cut to specific sizes. In about 1900 the sanitary can was invented. In this process, machines form cans with airtight seams. A processor buys cans with one end open and seals them after filling. Some cans are made of steel coated with tin and are often glazed on the inside to prevent discoloration. Some are made of aluminum. Frozen foods are packaged in containers made of layers of fiberboard and plastic or of strong plastic called polyethylene. Freeze-dried and dehydrated foods are packed in glass, fiberboard, or cans. Research The research activities of processed food scientists are numerous and varied. New packaging materials, the nutritional content of processed foods, new processing techniques, more efficient use of energy and water, the habits and desires of today's consumer, more efficient equipment, and transportation and warehousing innovations are some of the subjects being studied. The challenge of the food researcher is to discover better and more efficient ways to process, transport, and store food. Processed foods have changed the world. In developed countries they are part of almost everyone's diet. The United States, Canada, France, Germany, Italy, Portugal, Spain, and the United Kingdom all produce large quantities of processed foods, which they sell domestically and abroad. In the United States in the early 1980s, annual production of fruit was 1.8 billion kilograms canned, 1.4 billion kilograms frozen, and 1.1 billion kilograms in fruit juice; production of vegetables was 1.4 billion kilograms canned and 3.2 billion kilograms frozen. From the modest canning industries in 1813 to the sophisticated food processing plants of today, food processors have provided the world with more healthful diets, food combinations never before possible, and a convenience unimagined 200 years ago. We as consumers can only imagine what further achievements will be made in the field of food preservation. But one thing is for certain; it is all for the general good of mankind...to reduce starvation levels globally and insure the availability of nutritive foods to all. It is through this way that man survives...and fits in Darwin's hypothesis of the survival of the fittest. For it is only the fit who will prevail in the end. f:\12000 essays\health & humanities (196)\Genetically Altered Food.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Environmental sctence Genetically Altered Foods It is quite evident that as technology advances m the scientific sense, we as Americans are becoming more interested. One of the conflicts that have raised concern here lately is that on genetically altered foods. By no surprise, one of the major questions of many is whether or not these foods are safe. As altered foods continue to be produced, we will begin to see much controversy. As the growing industry expands, soils the research, not only nationally, but also internationally. This topic has proven to be an environmental issue, particularly by the money that has been involved, as well as the concern for ones health. To the knowledge of most, the United States can be very manipulative or should I say persuading, so therefore it doesn't take much on their part to convince the regulators that the crops are safe. Those who protest have debated on a list of concerns dealing with this issue. For example, one of which brings a question to the environmental policies. It states that Stimulating the resistance of cslve use or such herbicides (Nature 559). " A lot of concern has come from one certain crop and that is maize, which was altered to an extent. The development was done by a company known to be Swiss, called "Ciba-Geiby". That which was debated dealt with the Advisory Committee on Novel Foods and Processes (ACNFP) stating that "A gene resistant to the antibiotic ampicillin used in an early stage of the developmental process, could theoretically be passed to man via bacteria lodged in the gut of animals which eat the maize unprocessed (559)". In response to this attack, the company said that there would need to be a great amount of events that would have to take place. The transferring of DNA to the bacteria is just one of which was addressed. Therefore, the issue isn't settled. One then can only assume that until a hault is put on altering, the industry will keep producing. My opinion is that as long as there has been no proof of illnesses with the experiments and procedures that have taken place, well then I am for it. So I'm no doubt in agreement with the farmers, who are doing this in an attempt to lower costs. The opinion is very much valid, because if you can cut cost and increase in yields, well then more power to you. Another positive aspect is, as of right now not a single soul has ended up being harmed. The opposing's opinion is valid also, though I think they are trying to look to much into the issue by critiquing it, instead of backing the agri-business by creating a line of trust. I think that the farmers should continue to do what helps their livelihood, as long as no proof is found on dangers. If or when proof is found, I think the regulators should then step in and make some guidelines. So, if this is not hanning us and the environment, why not keep pursuing larger dollar signs? References Nature. "Distrust in Genetically Altered Foods" Vol. 303. 17 Oct 1996. issue 6601 pp. 559-60. Miller, G.T. 1996, Sustainmg the Earth. Wadsworth Publishing Company, New York, NY. f:\12000 essays\health & humanities (196)\gynecolegy and health.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Of all gynecologic malignancies, ovarian cancer continues to have the highest mortality and is the most difficult to diagnose. In the United States female population, ovarian cancer ranks fifth in absolute mortality among cancer related deaths (13,000/yr). In most reported cases, ovarian cancer, when first diagnosed is in stages III or IV in about 60 to 70% of patients which further complicates treatment of the disease (Barber, 3). Early detection in ovarian cancer is hampered by the lack of appropriate tumor markers and clinically, most patients fail to develop significant symptoms until they reach advanced stage disease. The characteristics of ovarian cancer have been studied in primary tumors and in established ovarian tumor cell lines which provide a reproducible source of tumor material. Among the major clinical problems of ovarian cancer, malignant progression, rapid emergence of drug resistance, and associated cross-resistance remain unresolved. Ovarian cancer has a high frequency of metastasis yet generally remains localized within the peritoneal cavity. Tumor development has been associated with aberrant, dysfunctional expression and/or mutation of various genes. This can include oncogene overexpression, amplification or mutation, aberrant tumor suppressor expression or mutation. Also, subversion of host antitumor immune responses may play a role in the pathogenesis of cancer (Sharp, 77). Ovarian clear cell adenocarcinoma was first described by Peham in 1899 as "hypernephroma of the ovary" because of its resemblance to renal cell carcinoma. By 1939, Schiller noted a histologic similarity to mesonephric tubules and classified these tumors as "mesonephromas." In 1944, Saphir and Lackner described two cases of "hypernephroid carcinoma of the ovary" and proposed "clear cell" adenocarcinoma as an alternative term. Clear cell tumors of the ovary are now generally considered to be of mullerian and in the genital tract of mullerian origin. A number of examples of clear cell adenocarcinoma have been reported to arise from the epithelium of an endometriotic cyst (Yoonessi, 289). Occasionally, a renal cell carcinoma metastasizes to the ovary and may be confused with a primary clear cell adenocarcinoma. Ovarian clear cell adenocarcinoma (OCCA) has been recognized as a distinct histologic entity in the World Health Organization (WHO) classification of ovarian tumors since 1973 and is the most lethal ovarian neoplasm with an overall five year survival of only 34% (Kennedy, 342). Clear cell adenocarcinoma, like most ovarian cancers, originates from the ovarian epithelium which is a single layer of cells found on the surface of the ovary. Patients with ovarian clear cell adenocarcinoma are typically above the age of 30 with a median of 54 which is similar to that of ovarian epithelial cancer in general. OCCA represents approximately 6% of ovarian cancers and bilateral ovarian involvement occurs in less that 50% of patients even in advanced cases. The association of OCCA and endometriosis is well documented (De La Cuesta, 243). This was confirmed by Kennedy et al who encountered histologic or intraoperative evidence of endometriosis in 45% of their study patients. Transformation from endometriosis to clear cell adenocarcinoma has been previously demonstrated in sporadic cases but was not observed by Kennedy et al. Hypercalcemia occurs in a significant percentage of patients with OCCA. Patients with advanced disease are more typically affected than patients with nonmetastatic disease. Patients with OCCA are also more likely to have Stage I disease than are patients with ovarian epithelial cancer in general (Kennedy, 348). Histologic grade has been useful as an initial prognostic determinant in some studies of epithelial cancers of the ovary. The grading of ovarian clear cell adenocarcinoma has been problematic and is complicated by the multiplicity of histologic patterns found in the same tumor. Similar problems have been found in attempted grading of clear cell adenocarcinoma of the endometrium (Disaia, 176). Despite these problems, tumor grading has been attempted but has failed to demonstrate prognostic significance. However, collected data suggest that low mitotic activity and a predominance of clear cells may be favorable histologic features (Piver, 136). Risk factors for OCCA and ovarian cancer in general are much less clear than for other genital tumors with general agreement on two risk factors: nulliparity and family history. There is a higher frequency of carcinoma in unmarried women and in married women with low parity. Gonadal dysgenesis in children is associated with a higher risk of developing ovarian cancer while oral contraceptives are associated with a decreased risk. Genetic and candidate host genes may be altered in susceptible families. Among those currently under investigation is BRCA1 which has been associated with an increased susceptibility to breast cancer. Approximately 30% of ovarian adenocarcinomas express high levels of HER-2/neu oncogene which correlates with a poor prognosis (Altcheck, 375-376). Mutations in host tumor suppresser gene p53 are found in 50% of ovarian carcinomas. There also appears to be a racial predilection, as the vast majority of cases are seen in Caucasians (Yoonessi, 295). Considerable variation exists in the gross appearance of ovarian clear cell adenocarcinomas and they are generally indistinguishable from other epithelial ovarian carcinomas. They could be cystic, solid, soft, or rubbery, and may also contain hemorrhagic and mucinous areas (O'Donnell, 250). Microscopically, clear cell carcinomas are characterized by the presence of variable proportions of clear and hobnail cells. The former contain abundant clear cytoplasm with often centrally located nuclei, while the latter show clear or pink cytoplasm and bizarre basal nuclei with atypical cytoplasmic intraluminal projections. The cellular arrangement may be tubulo acinar, papillary, or solid, with the great majority displaying a mixture of these patterns. The hobnail and clear cells predominate with tubular and solid forms, respectively (Barber, 214). Clear cell adenocarcinoma tissue fixed with alcohol shows a high cytoplasmic glycogen content which can be shown by means of special staining techniques. Abundant extracellular and rare intracellular neutral mucin mixed with sulfate and carboxyl group is usually present. The clear cells are recognized histochemically and ultrastructurally (short and blunt microvilli, intercellular tight junctions and desmosomes, free ribosomes, and lamellar endoplasmic reticulum). The ultrastructure of hobnail and clear cells resemble those of the similar cells seen in clear cell carcinomas of the remainder of the female genital tract (O'Brien, 254). A variation in patterns of histology is seen among these tumors and frequently within the same one. Whether both tubular components with hobnail cells and the solid part with clear cells are required to establish a diagnosis or the presence of just one of the patterns is sufficient has not been clearly established. Fortunately, most tumors exhibit a mixture of these components. Benign and borderline counterparts of clear cell ovarian adenocarcinomas are theoretical possibilities. Yoonessi et al reported that nodal metastases could be found even when the disease appears to be grossly limited to the pelvis (Yoonessi, 296). Examination of retroperitoneal nodes is essential to allow for more factual staging and carefully planned adjuvant therapy. Surgery remains the backbone of treatment and generally consists of removal of the uterus, tubes and ovaries, possible partial omentectomy, and nodal biopsies. The effectiveness and value of adjuvant radiotherapy and chemotherapy has not been clearly demonstrated. Therefore, in patients with unilateral encapsulated lesions and histologically proven uninvolvement of the contralateral ovary, omentum, and biopsied nodes, a case can be made for (a)no adjuvant therapy after complete surgical removal and (b) removal of only the diseased ovary in an occasional patient who may be young and desirous of preserving her reproductive capacity (Altchek, 97). In the more adv- anced stages, removal of the uterus, ovaries, omentum, and as much tumor as possible followed by pelvic radiotherapy (if residual disease is limited to the pelvis) or chemotherapy must be considered. The chemotherapeutic regimens generally involve adriamycin, alkylating agents, and cisPlatinum containing combinations (Barber, 442). OCCA is of epithelial origin and often contains mixtures of other epithelial tumors such as serous, mucinous, and endometrioid. Clear cell adenocarcinoma is characterized by large epithelial cells with abundant cytoplasm. Because these tumors sometimes occur in association with endometriosis or endometrioid carcinoma of the ovary and resemble clear cell carcinoma of the endometrium, they are now thought to be of mullerian duct origin and variants of endometrioid adenocarcinoma. Clear cell tumors of the ovary can be predominantly solid or cystic. In the solid neoplasm, the clear cells are arranged in sheets or tubules. In the cystic form, the neoplastic cells line the spaces. Five-year survival is approximately 50% when these tumors are confined to the ovaries, but these tumors tend to be aggressive and spread beyond the ovary which tends to make 5-year survival highly unlikely (Altchek, 416). Some debate continues as to whether clear cell or mesonephroid carcinoma is a separate clinicopathological entity with its own distinctive biologic behavior and natural history or a histologic variant of endometrioid carcinoma. In an effort to characterize clear cell adenocarcinoma, Jenison et al compared these tumors to the most common of the epithelial malignancies, the serous adenocarcinoma (SA). Histologically determined endometriosis was strikingly more common among patients with OCCA than with SA. Other observations by Jenison et al suggest that the biologic behavior of clear cell adenocarcinoma differs from that of SA. They found Stage I tumors in 50% of the observed patient population as well as a lower incidence of bilaterality in OCCA (Jenison, 67-69). Additionally, it appears that OCCA is characteristically larger than SA, possibly explaining the greater frequency of symptoms and signs at presentation. Risk Factors There is controversy regarding talc use causing ovarian cancer. Until recently, most talc powders were contaminated with asbestos. Conceptually, talcum powder on the perineum could reach the ovaries by absorption through the cervix or vagina. Since talcum powders are no longer contaminated with asbestos, the risk is probably no longer important (Barber, 200). The high fat content of whole milk, butter, and meat products has been implicated with an increased risk for ovarian cancer in general. The Centers for Disease Control compared 546 women with ovarian cancer to 4,228 controls and reported that for women 20 to 54 years of age, the use of oral contraceptives reduced the risk of ovarian cancer by 40% and the risk of ovarian cancer decreased as the duration of oral contraceptive use increased. Even the use of oral contraceptives for three months decreased the risk. The protective effect of oral contraceptives is to reduce the relative risk to 0.6 or to decrease the incidence of disease by 40%. There is a decreased risk as high as 40% for women who have had four or more children as compared to nulliparous women. There is an increase in the incidence of ovarian cancer among nulliparous women and a decrease with increasing parity. The "incessant ovulation theory" proposes that continuous ovulation causes repeated trauma to the ovary leading to the development of ovarian cancer. Incidentally, having two or more abortions compared to never having had an abortion decreases one's risk of developing ovarian cancer by 30% (Coppleson, 25-28). Etiology It is commonly accepted that cancer results from a series of genetic alterations that disrupt normal cellular growth and differentiation. It has been proposed that genetic changes causing cancer occur in two categories of normal cellular genes, proto- oncogenes and tumor suppressor genes. Genetic changes in proto-oncogenes facilitate the transformation of a normal cell to a malignant cell by production of an altered or overexpressed gene product. Such genetic changes include mutation, translocation, or amplification of proto-oncogenes Tumor suppressor genes are proposed to prevent cancer. Inactivation or loss of these genes contributes to development of cancer by the lack of a functional gene product. This may require mutations in both alleles of a tumor suppressor gene. These genes function as regulatory inhibitors of cell proliferation, such as a DNA transcription factor, or a cell adhesion molecule. Loss of these functions could result in abnormal cell division or gene expression, or increased ability of cells in tissues to detach. Cancer such as OCCA most likely results from the dynamic interaction of several genetically altered proto-oncogenes and tumor suppressor genes (Piver, 64- 67). Until recently, there was little evidence that the origin of ovarian was genetic. Before 1970, familial ovarian cancer had been reported in only five families. A familial cancer registry was established at Roswell Park Cancer Institute in 1981 to document the number of cases occurring in the United States and to study the mode of inheritance. If a genetic autosomal dominant transmission of the disease can be established, counseling for prophylactic oophorectomy at an appropriate age may lead to a decrease in the death rate from ovarian cancer in such families. The registry at Roswell Park reported 201 cases of ovarian cancer in 94 families in 1984. From 1981 through 1991, 820 families and 2946 cases had been observed. Familial ovarian cancer is not a rare occurrence and may account for 2 to 5% of all cases of ovarian cancer. Three conditions that are associated with familial ovarian cancer are (1) site specific, the most common form, which is restricted to ovarian cancer, and (2) breast/ovarian cancer with clustering of ovarian and breast cases in extended pedigrees (Altchek, 229-230). One characteristic of inherited ovarian cancer is that it occurs at a significantly younger age than the non-inherited form. Cytogenetic investigations of sporadic (non-inherited) ovarian tumors have revealed frequent alterations of chromosomes 1,3,6, and 11. Many proto-oncogenes have been mapped to these chromosomes, and deletions of segments of chromosomes (particularly 3p and 6q) in some tumors is consistent with a role for loss of tumor suppressor genes. Recently, a genetic linkage study of familial breast/ovary cancer suggested linkage of disease susceptibility with the RH blood group locus on chromosome 1p. Allele loss involving chromosomes 3p and 6q as well as chromosomes 11p, 13q, and 17 have been frequently observed in ovarian cancers. Besides allele loss, point mutations have been identified in the tumor suppressor gene p53 located on chromosome17p13. Deletions of chromosome 17q have been reported in sporadic ovarian tumors suggesting a general involvement of this region in ovarian tumor biology. Allelic loss of MYB and ESR genes map on chromosome 6q near the provisional locus for FUCA2, the locus for a-L-fucosidase in serum. Low activity of a-L-fucosidase in serum is more prevalent in ovarian cancer patients. This suggests that deficiency of a-L-fucosidase activity in serum may be a hereditary condition associated with increased risk for developing ovarian cancer. This together with cytogenetic data of losses of 6q and the allelic losses at 6q point to the potential importance of chromosome 6q in hereditary ovarian cancer (Altchek, 208-212). Activation of normal proto-oncogenes by either mutation, translocation, or gene amplification to produce altered or overexpressed products is believed to play an important role in the development of ovarian tumors. Activation of several proto- oncogenes (particularly K-RAS, H-RAS, c-MYC, and HER-2/neu) occurs in ovarian tumors. However, the significance remains to be determined. It is controversial as to whether overexpression of the HER-2/neu gene in ovarian cancer is associated with poor prognosis. In addition to studying proto-oncogenes in tumors, it may be beneficial to investigate proto-oncogenes in germ-line DNA from members of families with histories of ovarian cancer (Barber, 323-324). It is questionable whether inheritance or rare alleles of the H-RAS proto-oncogene may be linked to susceptibility to ovarian cancers. Diagnosis and Treatment The early diagnosis of ovarian cancer is a matter of chance and not a triumph of scientific approach. In most cases, the finding of a pelvic mass is the only available method of diagnosis, with the exception of functioning tumors which may manifest endocrine even with minimal ovarian enlargement. Symptomatology includes vague abdominal discomfort, dyspepsia, increased flatulence, sense of bloating, particularly after ingesting food, mild digestive disturbances, and pelvic unrest which may be present for several months before diagnosis (Sharp, 161-163). There are a great number of imaging techniques that are available. Ultrasounds, particularly vaginal ultrasound, has increased the rate of pick-up of early lesions, particularly when the color Doppler method is used. Unfortunately, vaginal sonography and CA 125 have had an increasing number of false positive examinations. Pelvic findings are often minimal and not helpful in making a diagnosis. However, combined with a high index of suspicion, this may alert the physician to the diagnosis. These pelvic signs include: Mass in the ovarian area Relative immobility due to fixation of adhesions Irregularity of the tumor Shotty consistency with increased firmness Tumors in the cul-de-sac described as a handful of knuckles Relative insensitivity of the mass Increasing size under observation Bilaterality (70% for ovarian carcinoma versus 5% for benign cases) (Barber, 136) Tumor markers have been particularly useful in monitoring treatment, however, the markers have and will probably always have a disadvantage in identifying an early tumor. To date, only two, human gonadotropin (HCG) and alpha fetoprotein, are known to be sensitive and specific. The problem with tumor markers as a means of making a diagnosis is that a tumor marker is developed from a certain volume of tumor. By that time it is no longer an early but rather a biologically late tumor (Altchek, 292). Many reports have described murine monoclonal antibodies (MAbs) as potential tools for diagnosing malignant ovarian tumors. Yamada et al attempted to develop a MAb that can differentiate cells with early malignant change from adjacent benign tumor cells in cases of borderline malignancy. They developed MAb 12C3 by immunizing mice with a cell line derived from a human ovarian tumor. The antibody reacted with human ovarian carcinomas rather than with germ cell tumors. MAb 12C3 stained 67.7% of ovarian epithelial malignancies, but exhibited an extremely low reactivity with other malignancies. MAb 12C3 detected a novel antigen whose distribution in normal tissue is restricted. According to Yamada et al, MAb 12C3 will serve as a powerful new tool for the histologic detection of early malignant changes in borderline epithelial neoplasms. MAb 12C3 may also be useful as a targeting agent for cancer chemotherapy (Yamada, 293-294). Currently there are several serum markers that are available to help make a diagnosis. These include CA 125, CEA, DNB/70K, LASA-P, and serum inhibin. Recently the urinary gonadotropin peptide (UCP) and the collagen-stimulating factor have been added. Although the tumor markers have a low specificity and sensitivity, they are often used in screening for ovarian cancer. A new tumor marker CA125-2 has greater specificity than CA125. In general, tumor markers have a very limited role in screening for ovarian cancer. The common epithelial cancer of the ovary is unique in killing the patient while being, in the vast majority of the cases, enclosed in the anatomical area where it initially developed: the peritoneal cavity. Even with early localized cancer, lymph node metastases are not rare in the pelvic or aortic areas. In most of the cases, death is due to intraperitoneal proliferation, ascites, protein loss and cachexia. The concept of debulking or cytoreductive surgery is currently the dominant concept in treatment. The first goal in debulking surgery is inhibition of debulking surgery is inhibition of the vicious cycle of malnutrition, nausea, vomiting, and dyspepsia commonly found in patients with mid to advanced stage disease. Cytoreductive surgery enhances the efficiency of chemotherapy as the survival curve of the patients whose largest residual mass size was, after surgery, below the 1.5 cm limit is the same as the curve of the patients whose largest metastatic lesions were below the 1.5 cm limit at the outset (Altchek, 422-424). The aggressiveness of the debulking surgery is a key question surgeons must face when treating ovarian cancers. The debulking of very large metastatic masses makes no sense from the oncologic perspective. As for extrapelvic masses the debulking, even if more acceptable, remains full of danger and exposes the patient to a heavy handicap. For these reasons the extra-genital resections have to be limited to lymphadenectomy, omentectomy, pelvic abdominal peritoneal resections and rectosigmoid junction resection. That means that stages IIB and IIC and stages IIIA and IIB are the only true indications for extrapelvic cytoreductive surgery. Colectomy, ileectomy, splenectomy, segmental hepatectomy are only exceptionally indicated if they allow one to perform a real optimal resection. The standard cytoreductive surgery is the total hysterectomy with bilateral salpingoophorectomy. This surgery may be done with aortic and pelvic lymph node sampling, omentectomy, and, if necessary, resection of the rectosigmoidal junction (Barber. 182-183). The concept of administering drugs directly into the peritoneal cavity as therapy of ovarian cancer was attempted more than three decades ago. However, it has only been within the last ten years that a firm basis for this method of drug delivery has become established. The essential goal is to expose the tumor to higher concentrations of drug for longer periods of time than is possible with systemic drug delivery. Several agents have been examined for their efficacy, safety and pharmacokinetic advantage when administered via the peritoneal route. Cisplatin has undergone the most extensive evaluation for regional delivery. Cisplatin reaches the systemic compartment in significant concentrations when it is administered intraperitoneally. The dose limiting toxicity of intraperitoneally administered cisplatin is nephrotoxicity, neurotoxicity and emesis. The depth of penetration of cisplatin into the peritoneal lining and tumor following regional delivery is only 1 to 2 mm from the surface which limits its efficacy. Thus, the only patients with ovarian cancer who would likely benefit would be those with very small residual tumor volumes. Overall, approximately 30 to 40% of patients with small volume residual ovarian cancer have been shown to demonstrate an objective clinical response to cisplatin-based locally administered therapy with 20 to 30% of patients achieving a surgically documented complete response. As a general rule, patients whose tumors have demonstrated an inherent resistance to cisplatin following systemic therapy are not considered for treatment with platinum-based intraperitoneal therapy (Altchek, 444-446). In patients with small volume residual disease at the time of second look laparotomy, who have demonstrated inherent resistance to platinum-based regimens, alternative intraperitoneal treatment programs can be considered. Other agents include mitoxantrone, and recombinant alpha-interpheron. Intraperitoneal mitoxanthone has been shown to have definite activity in small volume residual platinum-refractory ovarian cancer. Unfortunately, the dose limiting toxicity of the agent is abdominal pain and adhesion formation, possibly leading to bowel obstruction. Recent data suggests the local toxicity of mitoxanthone can be decreased considerably by delivering the agent in microdoses. Ovarian tumors may have either intrinsic or acquired drug resistance. Many mechanisms of drug resistance have been described. Expression of the MDR1 gene that encodes the drug efflux protein known as p-glycoprotein, has been shown to confer the characteristic multi-drug resistance to clones of some cancers. The most widely considered definition of platinum response is response to first-line platinum treatment and disease free interval. Primary platinum resistance may be defined as any progression on treatment. Secondary platinum resistance is the absence of progression on primary platinum-based therapy but progression at the time of platinum retreatment for relapse (Sharp, 205-207). Second-line chemotherapy for recurrent ovarian cancer is dependent on preferences of both the patient and physician. Retreatment with platinum therapy appears to offer significant opportunity for clinical response and palliation but relatively little hope for long-term cure. Paclitaxel (trade name: Taxol), a prototype of the taxanes, is cytotoxic to ovarian cancer. Approximately 20% of platinum failures respond to standard doses of paclitaxel. Studies are in progress of dose intensification and intraperitoneal administration (Barber, 227-228). This class of drugs is now thought to represent an active addition to the platinum analogs, either as primary therapy, in combination with platinum, or as salvage therapy after failure of platinum. In advanced stages, there is suggestive evidence of partial responsiveness of OCCA to radiation as well as cchemotherapy, adriamycin, cytoxan, and cisPlatinum-containing combinations (Yoonessi, 295). Radiation techniques include intraperitoneal radioactive gold or chromium phosphate and external beam therapy to the abdomen and pelvis. The role of radiation therapy in treatment of ovarian canver has diminished in prominence as the spread pattern of ovarian cancer and the normal tissue bed involved in the treatment of this neoplasm make effective radiation therapy difficult. When the residual disease after laparotomy is bulky, radiation therapy is particularly ineffective. If postoperative radiation is prescribed for a patient, it is important that theentire abdomen and pelvis are optimally treated to elicit a response from the tumor (Sharp, 278-280). In the last few decades, the aggressive attempt to optimize the treatment of ovarian clear cell adenocarcinoma and ovarian cancer in general has seen remarkable improvements in the response rates of patients with advanced stage cancer without dramatically improving long-term survival. The promises of new drugs with activity when platinum agents fail is encouraging and fosters hope that, in the decades to come, the endeavors of surgical and pharmacoogical research will make ovarian cancer an easily treatable disease. Bibliography Altchek, A., & Deligdisch, L. (1996). Diagnosis and Management of Ovarian Disorders. New York: Igaku Shoin. Barber, H. (1993). Ovarian Carcinoma: Etiology, Diagnosis, and Treatment. New York: Springer Verlag. Coppleson, M. (Ed.). (1981). Gynecologic Oncology (vol. 2). New York: Churchill Livingstone. Current Clinical Trials Oncology. (1996). Green Brook, NJ: Pyros Education. De La Cuesta, R., & Eichorn, J. (1996). Histologic transformation of benign endometriosis to early epithelial ovarian cancer. Gynecologic Oncology, 60, 238- 244. Disaia, P, & Creasman, W. (1989). Clinical Gynecologic Oncology (3rd ed.). St. Louis: Mosby. Jenison, E., Montag, A., & Griffiths, T. (1989). clear cell adenocarcinoma of the ovary: a clinical analysis and comparison with serous carcinoma. Gynecologic Oncology, 32, 65-71. Kennedy, A., & Biscotti, C. (1993). Histologic correlates of progression-free interval and survival in ovarian clear cell adenocarcinoma. Gynecologic Oncology, 50, 334-338. Kennedy, A., & Biscotti, C. (1989). Ovarian clear cell adenocarcinoma. Gynecologic Oncology, 32, 342-349. O'Brien, M., Schofield, J., & Tan, S. (1993). Clear cell epithelial ovarian cancer: Bad prognosis only in early stages. Gynecologic Oncology, 49, 250-254. O'Donnell, M, & Al-Nafussi, A. (1995). Intracytoplasmic lumina and mucinous inclusions in ovarian carcinoma. Histopathology, 26, 181-184. Piver, S. (Ed.). (1987). Ovarian Malignan f:\12000 essays\health & humanities (196)\Handicap essay.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ For a week in February when I was twelve, my mom and dad started to work hard to set up a Credit Union party. They asked me to help them so, everyday after I got out of school I would help them. Finally Friday came, a day before the big bash and I still had to help set up decorations. We were almost done but, my mom said, " Mike can you sent the tables and put up a few lights?" After a two hours the two hundred places I had to set up were finally done. My mom took me home. When I got home I started making plans for the night of the party. So, I called a few of my friends and ask what they were going to do. All of them had made plans. I wasn't too happy but didn't care too much because my mom told me that my cousin Bethany was coming up for the party. I was overjoyed to hear that because I didn't see her too much. After my mom told me the good news, I tried to find something to do. I tried watching television but that didn't work. Then I tried to play some videos games. I grew tried of that rather quickly. So, I deiced to get some much needed rest. The next morning I got up at eight o'clock because my dog Barney had to go outside. I knew he had to go outside because he started to cry. So, I let him out. Then I went to see if my mom or dad had made me breakfast. I looked and found nothing had been cooked for me. Which was really odd because every Saturday and Sunday morning they had made me breakfast since I could remember. My sister Amy was watching television. So, I asked her where mom and dad were. She said, " Dad had hurt his back and had to go to the hospital." I was very worried. I asked her how he did it. She said, " He was carrying some decorations for the party and he slipped on a patch of ice." Finally my mom and dad came home. My mom had to help him in the house because he could hardly walk. I asked him if he was still going to the party and he said, "No." So, I helped my mom put up the last of the decorations. After the party my dad was in lots of pain. He could hardly move without having great shooting pains in his back. My family and I had to help him with pretty much everything. Which was very hard on my dad because he is very independent. He couldn't get out of bed without help or tie his shoes. He found out that no matter how independent you are there will come a time when you need help from someone. He was very glad we were there to help. After a couple of weeks of caring for my father his back became well, He could pretty much do stuff on his own. My dad was very grateful to my family and I for helping him over come his handicap. f:\12000 essays\health & humanities (196)\Healing Health Care.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Levi Pulkkinen Op-Ed Paper March 10, 1997 Healing Health Care As Grant nears the end of his forty-fifth year old age begins to shed its ominous light over every aspect of his life. He has already watch four of his teeth rot out because, although he works nearly sixty hours a week, he cannot afford basic health care. As he enters the twilight years of his life, earlier than anyone should, he is faced with failing health and no way to pay the doctor bills. The fact that someone who has worked all their life may not be able to obtain adequate medical and dental care because of their station in life goes against all the ideals that have made America great. As we enter into the twenty-first century we see new cures and treatments springing into our clinics and homes at an unprecedented rate. Only a fool would argue that these advances are not helping millions, but the costs inherent with these new remedies make them inaccessible to many Americans who would benefit greatly from them. From 1971 to 1991 the price of health related goods and services climbed 30 percent faster that of other goods, placing far out of the financial reach of the working class of this nation. It is time to consider a true national health-care system, in order to insure that everyone, not just the wealthy, can enjoy good health. As it stands, America is the only civilized country where access to basic health care depends on where one works and how much one is paid. For many well insured people there is debate about our nation¹s stance on the separation between the individual and the state, but the fact of the mater is that if our friend Grant had been born five hundred miles to the North he would still have his teeth and a much brighter future. In Canada, where they have had a national health insurance since 1967, a citizen is guaranteed treatment for any illness that may afflict him or her. In addition to keeping their people heather, and as a result happier, the Canadian system has kept costs minimal while research and development has continued at the same, if not faster, pace that we see here. Around the globe we can see the correlation between national health care systems and better quality of treatment. In Japan, they have countered the medical problems inherent with a crowded society through national health insurance, and as a result enjoy a extremely high quality of living. Even here we have harnessed some of the power of collective medicine, through publicly funded institutions such as the Center for Disease Control and many smaller research projects. These projects, sponsored by state and federal, have yielded many important breakthroughs, yet many Americans cannot afford the technology that they helped to pay for. And if we continue on the course we have set for ourselves, more people will become medical have-nots. The problem of skyrocketing health costs is already beginning to force many employers to drop many important health benefits from the insurance plans they offer new hires, locking many people into jobs they no longer want for fear of losing benefits. Many small businesses have been forced to stop offering health insurance all together because they cannot afford to pay the bills. The American Hospital Association concluded that between 1995 and 1996 twenty percent of American workers would lose their employment-based insurance, and ten percent of them would lose their retirement coverage. When we add those millions to the millions who never had any health insurance to begin with we can begin to grasp the magnitude of the problem that we must face. We must also realize that those of us who know that if we became ill we would be cured can never fully comprehend what life would be like without that simple insurance. For the millions who cannot even afford to health care for themselves, let alone their families, the trouble is frighteningly real. And for the millions who are presently insured the problem is about to become much more real unless we act quickly. That even one person would have to be sick when they could be made well quite easily is a grave injustice, but that millions of hardworking Americans are robbed of proper health care makes a mockery of all of the principles that America has stood for. For a nation, our nation, to say that it stands for ³life, liberty, and the pursuit of happiness,² and then let its workers toil without hope of an end to their toil is idiotic. The question of national health care is really a test of America¹s intentions, of whether or not we are willing to sacrifice the good of the many for the good of the few. Let us choose to come together as a nation and beat this thing, so that we may continue to be the model of what a country can be, rather then what a country could have been. f:\12000 essays\health & humanities (196)\Health Disease and Disability.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Often we take our health, or the absence of illness, disease, or injury for granted until we become sick. It is then that we recognize the worth of being without ailments. It is then that we appreciate feeling strong, robust and healthy. Being healthy and, being physically and mentally sound, is associated with one's satisfaction with life. Developmental health psychologists - specialists who study the interaction of age, behavior, and health and gerontologists - specialists in the science of aging -- are piecing together the details of diet, exercise, personality and behavior that make it practical to shoot for 80, or even 120. People approaching middle age can expect a bonus of several years of extra living thanks to continuing medical progress against cancer, heart disease and stroke. Specialists in the field of aging, developmental health psychologists, and gerontologist , concentrate their area of study on determining health status over the course of adulthood, and determining the nature and origin of age-related diseases. They are also concerned with describing the effects of health on behavior and describing the effects of behavior on health. The goals of these specialists are: prevention of diseases, preservation of health, and improved quality of health for those suffering from disability and disease. What does it mean to be healthy? Health is a state of complete physical , mental, and social well-being and not merely the absence of disease, illness or infirmity. It is important to distinguish between disease and health. Disease is the prognosis of a particular disorder with a specific cause and characteristic symptoms. On the other hand, illness is the existence of disease and, the individual's perception of and response to the disease. Whether in sickness or in health age and the progression through life play a large part in our health and our developmental status. The role of age in regard to health is listed below: · Most young adults are in good health and experience few limitations or disabilities. Nearly 71% of adults older than 65 living in a community report their health as excellent, good, or very good. · Health and mobility decline with age especially after age 80. Disease is more common among older adults. · Most of the diseases of later life have their origin years earlier. · Income is related to perception of health. · The older the individual, the more difficult it is to recover from stress. · As an individual age, acute conditions decrease in frequency while chronic conditions increase in frequency. 4/5 of adults over 65 have at least one chronic condition. · Older adults may have multiple disorders and sensory deficits that may interact. Treatments may also interact. · In contrast to younger age groups, the elderly are likely to suffer from physical health problems that are multiple, chronic, and treatable but not curable. Acute illness may be superimposed on these conditions. Although there are factors that affect our health and the aging process that are not in our control , In a World Health article , K. Warner Schaie(1989), research director of the Andrus Gerontology Center at the University of Southern California, cites three reasons for optimism about future old age: The control of childhood disease, better education, and the fitness revolution.(p.2) The control of childhood disease often eliminates problems that occur later in life as a result of these diseases. Instead of going away, the minor assaults suffered by the body from disease, abuse and neglect can have "sleeper" effects. For example Chicken pox in a child can lead much later in life to the itching diseases known as shingles. Vaccines and other medicine have eliminated many of the childhood diseases. Schaie predicts that people who will become old 30 or 40 years from now will not have childhood diseases. Most people who are now old have had them all. Better education is also a reason for prolonged and healthier lives. Where a grade school education was typical for the older generation, more than half of all Americans now 30 or 40 years old have completed at least high school, and studies show that people with more education live longer. They get better jobs, suffer less economical stress, and tend to be more engaged with life and more receptive to new ideas. Finally, the fitness revolution has changed our habits with respect to diet and exercise and self-care. An article in Generations, Joyce Carrol Oates (1993) states, " per capita consumption of tobacco has dropped twenty-six percent over the past 15 years, and the drop is accelerating, promising a decrease in lung cancer. " Life-style changes and improved treatment of hypertension have already produced a dramatic national decrease in strokes.(p.13) In addition being aware of and accepting aging is an important process in aging. It is important to recognize that life not only has a beginning and a middle but also an end. It is important to recognize the live cycle and all that goes with it. The adult life cycle is divided into three main parts: Young adults, middle-aged, and older adults. There are characteristics of each division of adulthood. First, we will look at young adults. They are in generally good health. Respiratory aliments are their primary health problems (cold, headache, and tiredness). Allergies are their most common chronic illness. Fatal diseases are rare. The leading causes of deaths are for males, accidents and for females cancer. Aids is also a threat for this age group. The next area of concern is the middle-aged adults. There is a drastic change in health status from young adult to middle adulthood. Daily illnesses begin to occur such as: respiratory ailments, and musculoskeletal ailments. Chronic conditions begin emerging that limits daily activities such as arthritis, hypertension, chronic sinusitis, heart conditions, and hearing impairments. Fatal diseases also begin to appear for example: heart disease, hypertension, diabetes, arteriosclerosis, emphysema, and cancer. The leading causes of death among the middle-age are heart disease and cancer. Again there is a drastic change in health status from middle-age to older adults. Musculoskeletal problems are more common and more severe. Acute problems become more severe. Chronic conditions are dominant and more severe. Death rates rise rapidly among the elderly. The leading cause of death is heart disease, stroke, and cancer. In summary, people's evaluation of their physical health decline with age. Daily symptoms change with age. Acute conditions decrease with age. Chronic conditions increase with age. Nonfatal and life threatening diseases increase steadily with age. Of equal concern is the effect of gender and race on health and aging. However, inadequate attention has been given to the range of variations in social, cultural, and health characteristics within and between minorities and women. The time has come for more deliberate, purposeful, and thoughtful explanations of the effects of race and gender on health. Understanding adult development requires an understanding of the relationship between health, disease, disability and aging. Understanding and not being afraid of the aging process may slow the process. REFERENCE Oates, Joyce Carrol. (1993, Spring/Summer). The ageless self. Generations, (Vol. 17 Issue 2, p13). Schaie, Warner K. (1989, Nov). Looking ahead. World Health, pp.2-4. Health, Disease, and Disability Adult Psychology 10DEC96 f:\12000 essays\health & humanities (196)\Hearing and Deafness.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The ear is the organ of hearing and balance in vertebrates. The ear converts sound waves in the air, to nerve impulses which are sent to the brain, where the brain interprets them as sounds instead of vibrations. The innermost part of the ear maintains equilibrium or balance. The vestibular apparatus contains semicircular canals which in turn balance you. Any movement by the head, and this apparatus sends a signal to the brain so that your reflex action is to move your foot to balance you. The ear in humans consist three parts: The outer, the middle, and the inner portions. The outer ear, or pinna, is the structure that we call the ear. It is the skin covered flap of elastic cartilage, that sticks out from the side of the head. It acts like a funnel catching sound and sending it to the middle portion of the ear. The middle portion contains the ear drum and the connection between the pharynx and the drum, the Eustachian tube. The inner ear contains the sensory receptors for hearing which are enclosed in a fluid filled chamber called the cochlea. The outer and middle ears purposes are only to receive and amplify sound. Those parts ofd the ear are only present in amphibians and mammals, but the inner ear is present in all vertebrates. The ear can hear in several different ways. They are volume, pitch, and tone. Pitch is related to the frequency of the sound wave. The volume depends on the amplitude or intensity of the sound wave. The greater the frequency, the higher the pitch. Humans can hear about 30 and 20,000 waves or cycles per second. High pitch sounds produce more of a trebly sound, while low pitch sounds produce a rumbling bass sound. When a person loses these abilities to comprehend sound, it is referred to as deafness. It can be caused by disease, toxic drugs, trauma, or an inherited disorder. Those causes can be classified as conductive, sensorineural, or both. A conductive hearing loss results from damage to those parts of the ear which transmit sound vibrations in the air to the fluids of the inner ear. This type of damage is usually to the eardrum or small bones known as ossicles. Ossicles conduct sound from the eardrum to the cochlea. They cannot perform such an action if the eardrum is perforated, if the middle ear cavity is filled with fluid, or if the bones become separated, are destroyed by disease, or are overgrown by a spongy bone ( a disorder called otosclerosis). In conductive hearing loss, sound intensity is reduced, but sound isn't distorted. Sensorineural hearing loss is more resistant to therapy because it involves damage to the delicate sensory cells of the organ of Corti, which is located in the cochlea. Sensorineural hearing loss has to do with both distortion of sound and loss of sound intensity. The closer the damaged tissue is to the auditory cortex, the more complex and subtle are the types of distortions. The hair cells of the organ of Corti cannot grow once they are damaged. Sensorineural hearing loss is rarely reversible. The hearing losses caused by salicylates such as asprin and the early stages of Meniere's Disease are reversible, however. The latter condition is characterized by an imbalance of fluid pressures within the inner ear. If this imbalance is correct soon enough, before hair cell destruction has occurred, hearing will return to its normal level. Sensorineural hearing loss is often accompanied by ear noise, or tinnitus, which is a high-pitched ringing heard only by the patient. Because the inner ear has no pain fibers, damage is not accompanied by pain. Hearing loss is usually measured by an instrument called an audiometer which measures the weakest intensity at which a person can hear at most frequencies in the range of human hearing. The instrument is calibrated against the lowest intensity heard by normal humans at each frequency, according to an international standard. Audiometry can determine the amount of hearing loss-whether it is conductive or sensorineural in nature, and how much of each type of damage has occurred. Rehabilitation is available for patients with hearing losses. There are lots of programs and resources for these people. Most are special schools. One example might be Cleary's School for the Deaf. These schools try to provide an environment that is as close to a normal classroom as possible. As a matter of fact, sometimes they use regular classroom's but they provide special teaching assistants to help individual student's. The next step away from a normal classroom is the special schools. This may be a day school or a residential institution. Day schools are organized for one or more typed of handicap. Such schools also exist in all parts of the world. There are, for example schools for the blind, deaf, and mentally retarded in nearly every state in the US. For children who cannot obtain the schooling they require in their own communities, there are residential schools with dormitories and dining halls that enroll children on a 24 hour a day basis. These schools are designed to serve children who do not have access to normal services or whose handicap makes it difficult to for them to adapt to a regular school. Residential schools are the most common although occasionally there may be a school in a hospital. Hearing devices are also available. Hearing Aids operate on battery. They amplify the sound waves that the ear would normally receive. They range from $500 to $6000. INTERVIEW Question: How did you become about this disability? Answer: I was born with a hearing disability Q: When we talk, what exactly do you hear? A: The sound volume is lower but no distortion Q: Would you consider yourself hard on hearing? A: No, and I say no because I can hear when I pay attention but when I am not paying attention, it is like I am in my own world. Also, sometimes, I can see their lips moving which signals me to listen closely. Q: Did you ever go for any treatment? A: No, I didn't feel that it was necessary since it was just a matter of paying attention. Q: Do you wear any hearing devices? A: No, (same reason as last question) Q: Was it hard at all to communicate either as a child or as an adult? A: All the time I face the problem of someone talking to me and I don't even know it. Once someone mistakenly accused me of ignoring them. Q: Do you know what your overall score was on an audiometer? A: No, I was never tested f:\12000 essays\health & humanities (196)\Heart Attacks.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ HEART ATTACKS Heart attacks are the leading cause of death in the United States. Everyday approximately 1,500 people die from heart attacks. Thousands more suffer crippling effects of some form, and remain disabled for the rest of their lives. A simple definition of a heart attack is a sudden failure of the heart resulting from an occlusion or obstruction of a coronary artery. Basically, this means the heart is no longer receiving the blood supply it needs to function properly. A person having a heart attack experiences severe pain in the chest extending to the left shoulder and arm. Heart attacks occur for a variety of reasons. Diet, genetics, obesity, and lack of exercise are all contributors to heart attacks. Smoking and stress are the most widespread causes however, affecting 2.5 million people every year. Therefore, smoking and stress are two major causes of heart attacks. Smoking causes heart attacks. The tobacco in cigarettes and cigars contain a chemical called nicotine. When inhaled into the lungs, nicotine causes the release of hormones in the body. These hormones raise the blood pressure. Consequently, a person's heart rate increases 15 to 25 beats per minute. Nicotine also causes the blood vessels to contract. People who smoke have a harder time keeping their hands and feet warm because their blood does not circulate as well as it does in non-smokers. When the heart rate increases and the blood vessels remain constricted for an extended period of time, ten or more years, arteries begin to close up. When an artery feeding blood to the heart closes up, the heart can no longer function. This results in a heart attack. Stress is another cause of heart attacks. The causes of stress vary from person to person, although there are many stressors. Anger, fear, deadlines, work, conflict, and school can all be stressors. When an individual perceives a situation to be stressful, it is stressful. The body physically reacts to stress by activating the flight or fight response. In other words, the body physically prepares to run or fight. Hormones called adrenaline and noradrenaline are released into the blood stream. These hormones cause the metabolism, heart rate, blood pressure, breathing, and muscle tension to increase. In today's world, stress very seldom calls for an actual flight or fight response, but the body does not know the difference. Therefore, the physical release of all the energy built up in the body does not actually take place. This causes hypertension, otherwise known as high blood pressure. Secondly, hypertension creates strain on the arteries and contributes to the build-up of plaque in the arteries. Plaque is a sticky substance that sticks to the artery walls. Too much build up in the arteries causes them to close up, therefore not allowing blood to reach the heart. Finally, the heart collapses, and a heart attack has transpired. Smoking and stress are two major causes of heart attacks. However, avoiding heart attacks is actually quite simple. The American Medical Foundation has determined that if a person smokes 20 cigarettes a day for 20 years and they quit for a period of 3 years, the risk of having a heart attack decreases by 25%. When this person quits for 10 years the risk decreases to the likes of someone who has never smoked. Controlling the amount of stress in your life is also possible. Physical exercise, consciously confronting anger, and relaxation techniques, are all ways to manage stress and, therefore, reduce energy built up in the body. Meditation and yoga are two examples of relaxation. Given this information, people who smoke should quit and everyone should learn stress management techniques. This would reduce heart attacks in the United States by 67%. f:\12000 essays\health & humanities (196)\Hemispheric asymmetry of the cerebral cortex.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ As I was reading the text I came upon a section that I thought to be quite fascinating. It talked about people who have a brain that functions like two different people inside of the brain. This is of course the Split-Brain Personality. As I studied this topic in more detail I found it to be quite broad and yet very detailed. I found that I needed a dictionary to be able to read all of the medical journals and books that are out there, to be able to understand what it was exactly, that I was reading. But with a little study and research I found that this is a precise science that is still largely full of mysteries. The study of hemispheric asymmetry with in the cerebral cortex had long been a fascination with the human race. The ancient Aztec cultures used to perform a type of brain surgery on humans. This is evident from the human remains that we find with incisions and piece's missing of the skull. Whether or not these primitive surgeries were successful is unknown. The earliest way for man to observe the brain was by noticing brain damage to a particular area of the brain that was damaged. Such observations were first recorded some 5,000 years ago (Myers,1995). The most popular case is that of Phineas Gage a railroad worker that had severe frontal lobe damage. This happened when a rail road spike was shot through his head by a piece of dynamite. Miraculously he lived through the experience, but with a severe change in his personality. From this physiologists learned that personality was largely controlled from this point namely by removing a persons inhibitions. For the most part the brain has been a mystery that is waiting to be opened. The last two decades have witnessed a period of research on the human cerebral functions comparable to the great era of discovery initiated by Broca in 1861(Young, G,. Segalowitz, S,. Corter, C,. Trehub, S,.1983). We have leaned more in the past 20 years about the brain and it's hemispheric asymmetry than we had learned in combined previous history.(Kosslyn, 1993). Most of this new work has been devoted to the study of cerebral functions in adults, but recently there has been a growing interest in infants and young children most especially among the study of hand preference. About 10 percent of the human population in left-handed(Myers,1995). By looking at ancient writings this right-hand preference has seemed to develop right from the start of the human race. It also is apparent that from ultrasound devises that about 9 in 10 fetuses suck the right hand's thumb(Myers,1995). This would lead us to believe that handedness was an inherited trait. Their was a man by the name of George Michel, who in 1981 did a survey of new born babies and what side of their bodies they liked to lay their heads. He found that about two-thirds of 150 babies preferred to have their heads turned to the right while about only one-third laid their heads to the left. In a follow up survey Michel found that almost all of the right-sided babies were starting to reach with their right hand and again one-third of the left sided babies were reaching with their left hand(Myers,1995). In contrary, it is also found that handedness is one of the few genes that are not shared by genetically identical twins. So what is it exactly that develops handedness? Some speculate that the handedness of a person is evident in the brain and in its specialization concerning hemispheric asymmetry. Tests reveal to us that about ninety-five percent of right-handers process speech primarily in the left hemisphere(Myers,1995). While the study has found that left handed people are more likely to be a little more diverse or ambidextrous in their hemispheric asymmetry. But as we had learned in the first chapter is this a correlation or a causation? I personally feel that it is a correlation and not a causation. The brain is a very flexible and delicate instrument. It has the ability to adapt and change with different stimuli. The brain in left handed people I feel is just adapting to the use of a left hand preference and that is why it is more likely to be ambidextrous I would now like to talk about the asymmetry of the hemispheres. First, I will talk about the left side of the brain and then I will talk about the right. For well over a hundred years neuropsychologists have proposed that the left hemisphere plays a special role in both the production and perception of language(Hellige,1993). It has often been said that the left hemisphere is dominant for linguistic or verbal processing. This does not mean that the right does not have linguistic or verbal skills but merely suggests that the left is more capable and therefore more likely to process the language. This conclusion was reached after observation of people with language disorders that occurred after a left hemisphere was damaged. It is now a well documented fact that aphasia (the acquired loss of language) is far more likely after left-hemisphere than after right-hemisphere injury and that specific symptoms depends on which regions of the left hemisphere are injured(Hellige,1993). Studies of patients with unilateral brain injury have led to estimates that the left hemisphere is dominant for speech in approximately ninety-five percent of right-handed adults, with the right hemisphere being dominant for speech in the other 5 percent of right-handed adults(Hellige,1993). Such results demonstrate that the integrity of certain areas within the left hemisphere is necessary for the production of speech and certain other language related activities. Inside of the left hemisphere is a spot called the Broca's area(Myers,1995). This area is named after a French physician named Paul Broca. He reported in 1865 that damage to this area left a person unable to form words, but were still able to sing songs and still could comprehend speech. One would think that these two things are the same, but according to Broca's observation this is not so. Consequently this particular area was named after him. Latter another discovery was made by a man named Carl Wernicke. He discovered that if damage occurred to a specific area in the left temporal lobe this left people able to form words, but unable to make any sense of the words that they are saying(Myers,1995). An example of this is when a patient, with this particular part of the brain damaged, was asked to describe a pitcher of two boys stealing some cookies behind a woman's back, he would say, "mother is away her working her work to get her better, but when she's looking the two boys looking the other part. She's working another time"(Myers,1995) This area was later named after this man and is now known as Wernicke's area. Although damage to the left hemisphere is more likely to cause language disturbance than is damage to the right hemisphere, if left brain damage occurs in childhood recovery may be dramatic and virtually complete. The recovery in these cases is thought to be the result of rapid assumption of language processing in the right hemisphere(Young etal.,1983) When aphasia is associated with a stroke in adulthood, recovery is often a slow and incomplete process. Aphasiologists question whether this form of recovery is the result of gradual left to right switching language dominance, or rather the reorganization of the left hemisphere. Evidence is in favor of the latter. A man by the name of Kinsbourne, who in 1971 did a study on aphasic patients and language compensations. He staged serial unilateral intracarotid amobarbital injections on two right-handed aphasic patients. A third patient had a left side injection only. Left-side injections did not result in speech arrest, but arrest of all vocalization occurred with the right-side injections(Perecman,1983). For Kinsbourne, these results indicate that in these cases dominance for residual language had shifted to the right. I will now talk about different aspects of the right hemisphere. The right hemisphere has a little less organized principles and the processing elements are not as defined but nonetheless a valuable resource which will often go untapped or underutilized by the average person. In general, the right hemisphere controls the emotions of a person(Perecman,83pg69). In fact there is a theory now that negative emotions are created by the right hemisphere and the positive ones are done by the left. Neuropsychologists have found that motion picture sequences viewed with the left visual field are judged more negative than those viewed with the right field. Questions concerned with negative, rather that positive, produce greater leftward eye movements. Facial motor asymmetries are more likely to be biased to the left side for negative expressions, such as anger, sorrow, or disgust. Where the right side is more likely to favor the positive expressions (Perecman,1983). But in the contrary, studies have found that damage to the right parietal region impairs the identification and production of both positive and negative emotions, even if they are both conveyed verbally. Similar studies have found that there is no difference in the asymmetry of facial expressions when conveying emotions of negative or of positive nature. (Perecman,83pg70). Although some controversy exists as to the relative contribution of each hemisphere to the perception of emotion. The majority of experimental studies with normal subjects have found a right hemispheric superiority for processing a diversity of emotional stimuli including music, and facial expressions. Tonal sequences, invoking both positive and negative moods, are rated more quickly and accurately as well as judged more emotional when listened to on the left ear in contrast to that of the right. The left visual field can also detect emotions of a particular face more quickly as well as more accurately than that of the right visual field. I, myself am more of a right brain person. The tests that we have taken in class and all previous tests that I have taken tell me this. I think that this is why I make decisions more based on my emotions rather than on logic. This correlates with traits of most right-brained people. This paper has taught me a lot in the field of the brain. Such different aspects of the brain is what make each person distinctly different and human. f:\12000 essays\health & humanities (196)\Hemophelia.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Tim Poisal Hemophilia Biology-2nd period Hemophilia Hemophilia is a genetic blood disease, which is characterized by the inability of blood to clot, or coagulate even from minor injuries. This disease is caused by an insufficiency of certain blood proteins, called factors, that participate in blood clotting and often by sudden gene mutation. Therefore, with the absence of factors, the blood clotting process is prolonged. There are different types of hemophilia, hemophilia A and hemophilia B for example. Hemophilia A , the most common form is caused by the lack of factor VIII. In the second most common form of hemophilia, hemophilia B (also known as Christmas disease), factor IX is absent. The condition appears when the person is born. Also, the disease is hereditary, passed on from parent to child. Because of it's genetic makeup, hemophilia is carried by females however those affected are almost always males. In one-third of all cases hemophilia thought to be caused by spontaneous gene mutation with no family history. This is how females are able to be affected by hemophilia. Inheritance is controlled by a recessive sex-linked factor carried by the mother on the X chromosome. There is a fifty percent chance that the sons of a female carrier will have hemophilia. There also is a fifty percent chance that the daughters of a female carrier will be carriers of hemophilia. In addition, all daughters of men with hemophilia are carriers, but his sons are unaffected. Men cannot transmit hemophilia, and female carriers are free of the disease. Hemophilia is the most common hereditary blood disorder. Currently, approximately one in every 10,000 people in all parts of the world suffers from hemophilia. This blood related disease affects about 20,000 people in the United States. It affects males almost exclusively and knows no geographical or ethnic boundaries. Before medical advancement, those affected by hemophilia were not likely to live to see their adulthood. With proper treatment they can expect to lead full, normal lives. However, in some countries where treatment is not available or less than optimal, people have continued to die at young ages. f:\12000 essays\health & humanities (196)\Hepatitis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Hepatitis In modern society when a person gets sick with the flu or a cold they will usually go about their normal routine with the exception of a sneeze or a cough throughout the day. Sometimes things can be more than what they appear to be. The symptoms start out like the flu with coughing, fever, aches, and vomiting. However, the disease gradually worsens with symptoms of extreme weakness and excrushatating abdominal pain. By then it is usually too late when the person finds out that their liver is failing and that there disease is caused by one of the most contagious, dangerous and deadliest of viruses. These viruses that were initially concealed by flu like symptoms are now known collectively as the disease of Hepatitis. The disease of Hepatitis is actually by six different types of viral infections, namely, Hepatitis A, B, C, D, E, and G. Hepatitis descries the destructive affect of the viral invasion of the body and liver by six and separate viruses. Each type of viral infection varies from one to another in degree of severity. The names of the viruses are in alphabetical order corresponding to their discovery. There is also a non-viral Hepatitis which is caused by substance. One rumor that has spread about hepatitis is that a person can only contract Hepatitis if associated with HIV or AIDS. This is not true! Any one can become infected with Hepatitis. Unfortunately this is about all most people know of Hepatitis. They need to know the full horror of which the virus is capable. The first of the Hepatitis viral infection to be discovered is Hepatitis A. Hep. A is the mild mannered virus compared to the other viruses. It has the symptoms of influenza, fever, vomiting, loss of appetite, and weakening of body, but it does have some differences such as jaundice (a yellowing pigmentation of the skin and whites of the eyes) and urine appears to be a darker color. Jaundice is caused by an abundance of bilirubon which has not been removed from the blood system due to the infected liver. Hep. A does not have any special medications or antibiotics that can be used to treat or prevent this unpleasant virus. Some ways of avoiding this viral infection include washing the hands very carefully and not eating food or drink of others. People living in the same house or having close contact should clean the area very thoroughly. When a person has contracted and then recovered from this virus, he or she is now immune for the remainder of his or her life and will not carry the virus. The virus can affect anyone, but young children and older adults are more susceptible. People can transmit the virus directly to each other or indirectly by ingesting an infected persons food or drink. Then the person will ingest the contaminated food or drink. The disease can also be spread by contaminated drinking water, blood, body fluids and tissue, and intravenous needles used by drug users. The virus is contagious for a week before symptoms are experienced and continuing until recovery from the jaundice symptom (Hepatitis A 1996 pg. 1). The purpose of a persons liver is to filter out harmful toxins that get into the blood. An example of the function of the liver is similar to the use of a noodle strainer. The noodles are mixed with the water like the toxin mixed with the blood. The strainer removes the noodles from the water like the liver removes the toxin from the blood. The noodles stay in, but the water goes through. If a person were not to have a liver or it isn't functioning in the proper manner the person would suffer extreme blood poisoning and die. Hepatitis B can result in such malfunction of the liver. Hep. B causes the liver to become inflamed. Usually the people that get infected with Hep. B can fight off the virus, but there are some individuals that are unable to fight. This would include people infected with HIV or AIDS. The symptoms of Hep. B are very similar to Hep. A, loss of appetite, nausea and vomiting, fever, weakness of body which may last up to several weeks even months, abdominal pain, darkening of urine, and jaundice (American Liver Foundation June 1993 pg. 2). The only vaccine that is used on Hep. B is called Saccharomyces cerevesia (common bakers' yeast) (Hepatitis B 1992 pg. 4). There is still the old home remedy of lots of bed rest, but left untreated can result in cirrhosis or even liver cancer. Cirrhosis is a disease caused by a virus such as Hep. B attacking the liver cells resulting in the liver forming scare tissue. When there is scare tissue the liver becomes hard and lumpy and backs the blood flow up. This will cause the hemorrhaging of veins in the stomach and esophagus and will cause vomiting of blood. Hep. B is spread in many similar ways in which Hep. A is spread, in fact most all Hepatitis's are spread in the same way, but there are its differences. Hep. B can be spread through a wide range of human contact including sexual contact with an infected person, as well as simply living in the same area with a person who has the Hep. B virus. It is the most contagious of the Hepatitis viruses. It's even more contagious than HIV or AIDS, and it's the most commonly contracted of the viruses(American Liver Foundation June 1993pg. 3). Hepatitis C, formerly known as non-A, non-B Hepatitis is very similar to Hep. B in that they both cause cirrhosis and liver cancer, except that the Hep. C virus is caused by a bloodbrone virus. Symptoms of the virus are of the following: loss of appetite, fatigue, nausea and vomiting, abdominal pain, and jaundice. "Approximately twenty five percent of people infected with Hep. C will become sick with jaundice or other symptoms of Hep. Fifty percent of these persons may go on to develop chronic liver disease." Also some people that have been infected with the virus may remain contagious for years (Hepatitis C 1996 pg. 1). At the present moment there is no vaccine for the Hep. C virus, but there is a treatment that is used to help with chronic symptoms of the virus. This drug is called interferon alpha-2b. This drug aids in the recovery of the liver (MAYO 1993 pg. 7). The main causes of Hep. C transmission are the use of intravenous needles by drug users and blood transfusions ( since May 1990, blood donation centers have used a blood screen to detected Hep. C which has greatly diminished the number of cases) (Hepatitis C 1996 pg. 1-2). Hepatitis D, the super man of Hepatitis's. Hep. D is almost identical to Hep. B, except that D is about as twice as strong as B. The symptoms of this super virus is like an extreme case of the flu, loss of appetite, fever, weakness, vomiting, and jaundice, only that this virus can cause liver damage and be very dangerous if not cared for. The only treatment for this virus is to get medical attention as soon as possible and from there the doctors will determine what to do. Cases of Hep. D are only found in West Africa and Asia where it has become epidemic like paportions and cases reported in the U.S. are very rare. The reason the virus is so common is because in third world countries the water system is very poor. People are drinking and bathing in the same waters that are being contaminated with human feces. (American Liver Foundation June 1993 pg. 3). Hepatitis E is in a class all of its own. Scientist have researched this virus for short period of time and what they have discover is that it will, from studies, that this virus will kill women especially if they are pregnant. If a person wanted to treat Hep. E they would have to have medical attention as soon as symptoms appear. Hep. E is the rarest of all the different Hepatitis virus in the U.S. This is one of the viruses that is also very common in the third world countries. This is because of the neglect of medical attention and poor water systems. It has been discovered that the Hepatitis G virus is now in reality. The reason for the skip of the letter F is because it's in debate between scientist that do believe there is such a virus and scientist that don't believe it that it is a Hepatitis virus. The symptoms of the newest of virus's is that it "will set up shop in the liver, causing persistent infection, damage, and sometimes cancer." So in turn the virus starts in the liver and works its way out into the body. The person starts with jaundice and then the flu like symptoms appear. Scientist have traced a similar virus back a monkey. They believe that the virus has gone through a DNA mutation. Not only has it gone through a mutation from animal infection into a human infection, but it also has three separate spices of viruses inside of the one. The chance for a vaccine is far into the very future (Fackelmann April 1996 pg. 238-239). Medical attention is one of the most important things that need to be done when believed that one self has contracted one of these viruses. What is to be done when a person has contracted it from the doctor. The one that is supposed to help the sick not harm. This is a primal factor in today's life style. These viruses are being discovered every day. Hepatitis G was discovered just this year and right now scientist are discussing weather or not to consider the hepatitis F to be a virus or not. These things in life are not disappearing there just getting bigger and people are going to have to do something about these problems. Works Cited Fackelmann, Kathleen. "The Hepatitis G Enigma." Science News Apr 13, 1996: 238-239. UMI Company. CD-ROM. Unknown Author. "Hepatitis C." MAYO Summer 1993: 7-8. New York State Dept. of Health. Hepatitis A. [Online] Available gopher: hepa.txt at mole.health.state.ny.us, 11-13-96 New York State Dept. of Health. Hepatitis C. [Online] Available gopher: hepa.txt at mole.health.state.ny.us, 11-13-96 Rossi, Lisa. Hepatitis. [Online] Available usenet: http://www.upmc.edu/news/hepabg1.htm. Schlepphorst, Richard. October 6,1996. Doctor of Blessing Hospital. [Unpublished Interview]. Quincy, Il. Appendix A Schlepphorst, Richard. October 6, 1996. Doctor of Blessing Hospital. [Unpublished Interview]. Quincy, IL. Question I. What are the symptoms? Ans. The symptoms of hepatitis are very similar to the flu. Question II. How does one go by testing the virus? Ans. Blood test, urine. Question III. Is it a bacteria or virus? Ans. It is a virus, but then there is the non-viral hepatitis. Question IV. What is non-viral hepatitis. Ans. Non-viral hepatitis is caused by substance. Question V. What is hepatitis? Ans. It's a infection of the liver. Question VI. Which of the six viruses are most common in the U.S.? Ans. Hepatitis B. Question VII. How is the virus spread? Ans. It is spread through water, blood, body fluids. Question VIII. What is the treatment for hepatitis? Ans. Bed rest, medicine from doctors. Question IX. What is the most common age the virus is found in? Ans. Young children to older adults. Question X. Which of the six viruses is the most dangerous? Ans. Hepatitis D is known to be the deadliest, but is very rare in the U.S. f:\12000 essays\health & humanities (196)\HIV the Silent Killer.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Like the majority of the American population I have lived in a cloud of ignorance about the HIV and AIDS crisis. I have never know anyone close to me that has been infected with either of the two viruses. So when the option to research something to do with sexuality arouse I felt this would definitely further my education about a lethal killer that is roaming this earth. Since I knew next to nothing about this topic I will start from the begging of the disease and discuss where it's at now. The HIV and AIDS disease has been around for awhile although no one has been able to pin point it's origin. There are many theories floating around the medical world but the most predominant theory "is that the virus first attacked humans in Central Africa up to 100 years ago."(Kelly 524). It is said that the virus stayed mainly in this closed society until many years later. Many say the disease spread when international travel began to increase. The HIV and AIDS viruses were believed to arrive in the United States sometime during the nineteen seventies. It was a common disease between gay males and intravenous drug abusers. Now it is well known that the viruses have been transmitted through sexually, occasionally through blood and organ transplants. The acronym HIV stands for Human Immunodeficiency Virus, where as the acronym AIDS stands for Acquired Immunodeficiency Syndrome. When someone has contracted the HIV virus in almost all cases it produces the AIDS virus. Apparently there has been a controversy that HIV really isn't the cause of the AIDS virus, but careful research has proved without a doubt that it is the cause. Socially the production of the viruses has caused a lot of hate, prejudice, racism and above all homophobia. Many people only talk about the late stages of AIDS but HIV does not always produce the AIDS virus. If the HIV virus is caught in the early stages it is possible to get treatment and delay the effects of the AIDS virus. When an individual contracts HIV they can expect a fever, swollen glands, and sometimes a rash. As the bodies system tends toward these symptoms the HIV virus may still be undetectable. This first stage is called primary HIV disease then moves onto chronic asymptomatic disease. With this stage comes a decline in the immune cells and often swollen lymph nodes. As time moves on the depletion of immune cells increases leaving the body open to opportunistic infection. This is where normal sickness, disease, and other things in the environment are now able to attack the bodies system. This stage is called the chronic symptomatic disease. A very noticeable symptom is a thrush, which "is a yeast infection of the mouth..."(Kelly 532). Also at this stage there can be infections of the skin and also feelings of fatigue, weight loss, diarrhea, etc. The actual period of the HIV virus really varies from person to person. Normally with in a year or two the serve stages of HIV set in. At this point in the victims life it is said they have progressed into the Acquired Immunodeficiency Syndrome(AIDS). This status is established when one or more of diseases have accumulated in the effected victims system. Many victims often have lesions appear on their skin or they begin to acquire a pneumocystic pneumonia. The final stage of the virus attacks the nervous system, "damaging the brain and the spinal cord."(Kelly 532). This can lead to a number of problems in the body: blindness, depression, loss of body control, loss of memory. This can often last for months before the victim finally passes away. Once the HIV virus enters the body it infects the "T" cell the protectors of the immune system. Once they have attached to the T cell the HIV molecule sheds it's outer coating and then releases the Viral RNA material into the T cell. RNA and DNA are basically genetic blueprints for the body. When the Viral RNA enters the T cell it begins transforming into the more complex Viral DNA. This occurs because the virus brings along an enzyme with it that causes the change. Modern medicine uses the drug AZT to put the transformation on hold. After the Viral RNA changes to Viral DNA it then penetrates the nucleus of the T cell. It connects with the cell DNA and awaits the opportunity to produce more Viral RNA. When the victim comes under stress or infection the cells break and become Viral proteins and begin making more Viral RNA. They are then re-coated so they can regain entry into other T cells, mass producing the virus throughout the immune system. The HIV virus is of the retrovirus type, this is a class of viruses that reproduces with the aids of an enzyme that it carries with it. This allows the virus to transform the genetic RNA into DNA in the host cell. Basically when the virus attacks a cell it tells it's self, to transform from the RNA to the DNA form and then mass produce the Viral RNA. Unfortunately for modern chemists and biologists the HIV strand is so complex with so many genetic codes it is almost impossible to break down. The thing that makes the HIV virus so lethal is that it attacks directly into the primary defense cells of the immune system leaving it open for attack. No one knows exactly how HIV destroys CD4 cells, they are white blood cells that play an integral part in the bodies immune system. One possibility is that they directly kill the cell either by causing them to clump together or by disintegrating them. A more recent theory is that HIV instills a genetic program inside the CD4 cell that causes the premature death of thousands of these cells. All cells in the body have a program to die, this helps keep renewing the body with fresh cells. That process is called apoptosis, and it's believed that HIV increases the rate of this process without the renewal. HIV is very good at cloaking it's self in the body. This way the virus can move through the body almost undetected killing cells along the way. It also makes it's way to the neuroglial cells in the brain and spine. This is the main problem defending against HIV, it's is so quick and sneaky that the body can't find it. The HIV and AIDS viruses are technically more complex than what I explained. Now that I talked about what it does to the body I it's very important to understand how it is transmitted from person to person. It has been documented that the HIV virus is transmitted by the direct transfer of bodily fluids. Those fluids could be either blood or sexually transmitted fluid. Since the virus can stay undetected in a carriers body it is often transmitted to others without knowledge. Those infected with the HIV virus and have acquired AIDS are more likely to transmit the disease compared to those without AIDS. This does not mean that the virus will not be transmitted at all. The virus normally enters the body through "internal linings of organs(such as the vagina, rectum, urethra within the penis, or mouth)or through openings in the skin, such as tiny cuts or open sores."(Kelly 534). It has also been proven that the virus can be transmitted from a mother to a baby via breast milk. It has also been shown that HIV can be found in urine, tears, saliva, and feces but no evidence of transmission through these fluids. There is hard evidence stating that HIV has been transmitted by the following; sexual intercourse, either anal or vaginal. Contact with vaginal fluid and semen, transplanted organs or blood from an infected person. The contact with infected blood, the sharing syringes by drug users, tattoo needles that are not sterilized, etc. There is still no really strong evidence that HIV has been transmitted through oral sex. Although there has been documented cases in which it has been transmitted from a male's semen through oral sex. There is far less evidence of male's or female's contracting the virus through oral sex performed on a female. It has been said that the virus can not be transmitted trough kissing but experts can not rule out this possibility. Some have said that prolonged "French" kissing, open mouth with the switching of saliva, could possibly transmit the virus. There has been no evidence that casual contact has or ever will transmit the disease. This is were many social problems come into effect. Many be tend to isolate people that they know have contracted the virus because they are ignorant to how the disease is transmitted. "About 5 percent of individuals infected with HIV have remained asymptomatic even without any antiviral treatment."(Kelly535). It's not known what causes this very rare occurrence but many doctors are still researching why it happens. Can the body reject the HIV and AIDS virus, unfortunately until now the answer remains no for most. The virus defeats the immune system leaving the vulnerable to other diseases. Those victims that already have a more defeated immune system and then contract HIV will be more likely to acquire AIDS at a much faster rate than normal. Although someone is infected with HIV this does not necessarily mean they are sentenced to die. Few people that have been diagnosed seemed to have rid themselves of the deadly virus. Most people tend to make a drastic change in their lifestyle. A change in eating habits, vitamins, exercises, and work habits. Some of these victims often live for many years after they are diagnosed. Testing for the HIV and AIDS virus is a process that has become a regular occurrence in most people's lives. When the virus enters the body it reacts by producing antibodies. Unfortunately these antibody's can go undetected for sometime leaving people with the false hope that they are HIV negative. In most people it has been estimated that these antibody's appear with in six months or longer. This is why the medical profession suggests regular HIV testing on a six month interval. There are two tests mainly used to detect the HIV and AIDS virus. The ELISA and the Western blot. ELISA stands for, Enzyme-Linked Immunosorbent Assay, it is an inexpensive test but often gives false positive diagnoses. When a positive result returns it's often followed by the Western blot. This is a much more expensive and lengthy test that has to be interpreted by trained professionals. The major problem with HIV testing is that it often develops very slowly in the human body, staying virtually undetected for a long time. This is why so many people can be not carrying the disease without even knowing it. There are three possible outcome with the testing technology that is available now. First, positive conformation that HIV antibodies are present through out the body. Second, positive conformation that the HIV antibodies are not present through out the body. Third, the uncertain result that HIV antibodies are present in the body. f:\12000 essays\health & humanities (196)\HIV.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ AIDS Acquired Immune Deficiency Syndrome Timur Eren Spring '96 HPE12 BACKGROUND Since the first AIDS cases were reported in 1981, through mid-1994 more than 402,000 AIDS cases and more than 241,000 deaths have been reported in the United States alone. This is only the tip of the iceberg of HIV infection, however. It is estimated that nearly 1 million Americans had been infected with the virus through the mid-1990s but had not yet developed clinical symptoms. In addition, although the vast majority of documented cases have occurred in the United States, AIDS cases have also been reported in almost every country in the world. Sub-Saharan Africa in particular appears to suffer a heavy burden of this illness. No cure or vaccine now exists for AIDS. Many of those infected with HIV may not even be aware that they carry and can spread the virus. Combating it is a major challenge to biomedical scientists and health-care providers. HIV infection and AIDS represent among the most pressing public-policy and public-health problems worldwide. COSTS I think that the AIDS epidemic is having a profound impact on many aspects of medicine and health care. The U.S. Public Health Service estimates that in 1993, the lifetime cost of treating a person with AIDS from infection to death is approximately $119,000. Outpatient care, including medication, visits to doctors, home health aids, and long-term care, accounted for approximately 32 percent of the total cost. Persons exposed to HIV may have difficulty in obtaining adequate health-insurance coverage. Yearly AZT expenses can average approximately $6,000, although in 1989 the drug's maker did offer to distribute AZT freely to HIV-infected children. The yearly expense for DDI is somewhat less at $2,000. Therefore, if the AIDS epidemic is not controlled, its cost to American taxpayers will become overwhelming. I feel that the effects of the epidemic on society at large are increasingly evident. AIDS tests are now required in the military services. Various proposals have been made for mandatory screening of other groups such as health-care workers. A number of nations, including the United States, have instituted stringent rules for testing long-term foreign visitors or potential immigrants for AIDS, as well as testing returning foreign nationals. In the United States one frequent phenomenon is the effort to keep school-age children with AIDS isolated from their classmates, if not out of school altogether. Governmental and civil rights organizations have countered restrictive moves with a great deal of success. There is little doubt in my mind that the ultimate physical toll of the AIDS epidemic will be high, as will be its economic costs, however the social issues are resolved. Concerted efforts are under way to address the problem at many levels, and they offer hope for successful strategies to combat HIV-induced disease. Politics and AIDS In the United States, I feel that AIDS provoked a grass-roots political response, as well as government action. First evident in urban gay men, AIDS moved an already politically organized gay community to create service, information, and political organizations, such as Gay Men's Health Crisis (GMHC) and AIDS Coalition to Unleash Power (ACT UP). Those groups have lobbied the federal government for funding and favorable policies. ACT UP was formed in 1987 to urge speed in drug approval and to protest high prices for AIDS drugs. By successfully promoting reforms, ACT UP and other advocates have provided a model for other disease groups, particularly breast cancer advocates. During the 1980s, AIDS groups accused the government of neglecting its duty in responding to AIDS. Critics cite government reluctance to promote condom use as a prevention method, and the fact that President Ronald Reagan did not mention AIDS publicly until April 1987, six years after the epidemic began. The epidemic's spread to people of color, often drug users and their intimates, introduced race into the politics of AIDS. Competition for funding and influence arose between gay and minority groups. Disagreements emerged about prevention methods, in particular needle exchange programs. Many African Americans and Hispanics viewed needle exchange as promoting drug use in their communities, while others cited its role in curbing HIV transmission. The AIDS activists have helped increase federal funding for AIDS from an initial $5.6 million in 1982, to over $2 billion in 1992. The 1990 Americans with Disabilities Act included protection from discrimination for people with HIV; the Ryan White Comprehensive AIDS Resources Emergency Act was passed to provide funds to cities hard hit by AIDS. CONCLUSION As you can see, AIDS does not discriminate by color nor socio-economic status as was once believed. It has become an epidemic for the entire nation and will need the cooperation of everyone to control. Already, many private and government organizations have been created to help deal with the problem. And millions of dollars are being spent in research and treatment, as well as in helping people cope with the problem. The social impact of AIDS is substantial and it can no longer be ignored. f:\12000 essays\health & humanities (196)\Hospice A vital department in a community hospital.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ General Purpose of the Department: As we have learned, the hospice idea is not new. Literally meaning "given to hospitality," hospices provided comfort, kindness, and nourishment to people in need hundreds of years ago. Today, hospices offer comfort to people as they near the end of life's journey. Hospice is a special way of caring for people with terminal illnesses and their families. It is a multidisciplinary health care program that is responsible for palliative and supportive care with consideration of the patient's and families wishes. Hospice focuses on care, not cure. Hospice care is important because it provides many benefits that aren't possible in a traditional acute or long-term health care setting. Within hospice, the family of the patient is directly involved in making decisions and helping their loved one. Hospice also gives the patient to have a great amount of control by deciding where they want to spend the rest of their lives. It can also help make choices about advanced directives which we will discuss shortly. Major Functions of the Department: Hospice is a very unique department because it truly looks at the "big picture" and treats a spectrum of patient needs equally. Special attention is given to: Physical needs - this is the first and foremost function. Within hospice you are dealing with a patient that has been given a diagnosis of having 6 months or less to live. For many patients, relieving pain through medication is an important part of hospice care. I have provided you with a list of ways that patients are made more comfortable. A goal of hospice it to help patients use their physical abilities as fully as possible. Social Needs - Sometimes little things make all the difference to people. Although these patients may not be as active as before their illness, you can see on your handout a list of things that they probably still enjoy. Hospice can help to make these things happen, as well as provide assistance with practical issues like putting finances in order. Emotional Needs: Hospice can help patients cope with loneliness, isolation, and the fear of being abandoned. This is outlined on your handout as to how the hospice staff accomplishes this. Hospice also helps friends and families of the patient express their emotions through group and bereavement counseling. Spiritual Needs - the realization that a person's spirituality is of a daily concern to the patient has led hospice care to this area. Hospice tries to organize the types of care outlined on your handout. Members of the clergy can also help family and friends who are in need of spiritual support. As you can now see, there are many areas of patient care that hospice has a direct focus on. This now brings me to the subject of the people involved: the staff. Staffing of the Department: As with all departments, the actual number of staff will vary by facility. However, there are required members of the staff that must have certain qualifications. For instance, there must be nurses to do in-home care. These nurses can be either RN's or LPN's depending on the level of patient care involved. In addition is a staff physician who consults with the patient's primary care physician and helps to oversee the patient care plan. In addition, there are is a staff psychiatrist and a psychologist who do individual and family counseling, volunteer visits, holiday programs, support groups, and learning about loss and grief. Some hospices help with funeral arrangements. Also part of the hospice team are the hospice coordinator or director, other consulting physicians and specialists, a member of the clergy, a social worker, a dietitian, a pharmacist, therapists who perform physical and occupational therapy. Also there are home care aides and volunteers. Hospice members offer care for patients on-call 24-hours a day. Depending on the patient's needs at the time, hospice care is provided in a variety of settings including the patient's home, inpatient facilities including a nursing home, or a combination of venues. . Special Requirements: Staff needs to be oriented in the special situations that arise in dealing with a patient in their own home. Respect for the patient and their surroundings is of utmost importance. Being empathetic to even the smallest of concerns is the mark of a well-trained care-giver. There must be an emphasis on maintaining a quality of life that the patient as well as the family feel comfortable with. Since the patient is treated by such a wide variety of workers, there are weekly case management meetings which are mandated by Medicare, but often also influenced by hospital policy to ensure quality of care. It is at this time that information is shared by all who have had contact with the patient and any concerns are addressed. This helps for the staff to work out their feelings as well - because in hospice care where you may treat a patient for a year or more, bonds begin to form. Reports, Statistics, and Records: I would like to spend a bit of time on this subject in consideration of the nature of our program. As director of the hospice program, one duty that would fall on you is the compilation of statistics, the submitting of reports, and the overseeing of the legal medical record. Since hospice keeps it's own legal medical record on their patients, their relationship with the medical record department is very limited. If a hospice patient checks in to the hospital, there must be a release of information from hospice to the hospital in order to share information. Upon death, however, the hospice record is integrated with any hospital records into one main file which is archived according to hospital policy on deceased charts. Statistics compiled by this department include those reportable to the Montana Hospital Association such as number of referrals and number of Medicare patients. Reportable to Medicare are unduplicated patient days, social security numbers, diagnosis, and other demographic information. Hospital statistics may typically include patient days, cost of supplies and equipment broken down through the different disciplines, pharmacy costs, and number of visits with the patient. Also implemented would be a quality assurance program which gathers input from the patient in the form of a pain questionnaire. A questionnaire is also given to the family after the patient dies to evaluate their satisfaction with the way that hospice treated the patient as well as the family unit. In your folder, you will se on the right side an intake check list which is completed by the supervisor. When all necessary forms are in the chart, hospice care officially begins. (Review info in chart) Along with these forms, there will also be nursing notes, medication orders, doctors orders, among other forms that are typical for an inpatient record in an acute care setting. JCAHO Standards: In reviewing Joint Commission's Accreditation manual for Health Care Organizations, I came across many standards that directly apply to hospice care. You can see on your handout a sampling of a standard from different sections in the manual. For the first section I am covering, Rights , Responsibilities, and Ethics (RI) under the treatment section is RI.1.2 which reads: [The organization has a functioning process in place to address and respect patient rights: the process is supported by a framework that includes the following mechanisms:] Mechanisms for the individual and, when appropriate, the family to receive sufficient information on the individual's responsibilities in the care process This can be implemented in hospice by informing, assessing, educating patient and their families in their responsibilities in the care process such as administering pain medications or treatments. The next section I am covering is Assessment (PE). The standard I am looking at is PE.1.2 which reads: The scope and intensity of any further assessment is determined by the patient's diagnosis, condition, need and desire for care and services, response to previous care, and the care or service setting. Implementing this standard in hospice would be for hospice patients and families, the bereavement assessment begins at admission, and is updates as appropriate during the patient's time in the program, at the time of death, and during bereavement follow-up. Next is Care, Treatment, and Services (TX). Standard TX1.2.2 reads: When applicable to the care provided, the physician or other authorized individual reviews and revises therapeutic and diagnostic orders as necessary. So, the provision of Hospice care is in accordance with therapeutic orders from the patient's attending physician and/or the hospice medical director and the hospice interdisciplinary team. This might include hospice standing orders for symptom management (for example, control of nausea and vomiting, bowel management) and other palliative care measures such as oxygen, as needed. The next section deals with Education (PF). Standard PF.2 reads: The patient and family receive education and training specific to the patient's assessed needs, abilities, and readiness, as appropriate to the care and service provided by the organization. As part of it's overall education plan, a hospice develops written teaching materials geared toward family members and caregivers on caring for a hospice patient in the home. The teaching materials address such aspects as medication administration, caring for a bed bound patient, skin care, nutrition, signs and symptoms of impending death, and the preparation for and handling of a death in the home. Hospice interdisciplinary team members also teach the family about such issues as communication and coping styles; the psychosocial and spiritual needs of dying people such as "needing permission to die," "saying good-bye" ; letting go of the patient; and managing grief and loss. Though there are other important sections in the manual, because of time limitations, I am going to cover only one more section which is Surveillance, Prevention, and Control of Infection. IC.1 reads: Processes are in place to reduce risks for infections in patients and staff members. This is implemented by determining that the surveillance of infections among patients and staff will include tuberculosis, hepatitis, and HIV, as well as new incidences of central venous catheter infections or wound infections. Surveillance identifies a trend of staph infections among patients with pressure ulcers, and planning includes the identification of mechanisms both to prevent skin breakdown and prevent infections in acquired open wounds. This section of the manual is the real meat of keeping in line with OSHA guidelines. In hospice care, the control of bloodborne pathogen exposure is utmost and it is required that there be an exposure control plan that is to be read by employees and signed as having been read. Complying with OSHA guidelines is looked at very closely by the risk management committee who keeps a sharp eye on Home Health because so many potentially dangerous situations arise when entering a patient's home. Cost Containment Issues: Within hospice, there is not a too big of a worry on cost of care. Because of Medicare's Hospice Plan paying 100% of the patient's bill, the patient has less to worry about. As in most other areas of the hospital, however, risk management and the potential for loss of dollars is the major concern. As I mentioned, special care must be taken when entering a patient's home and additional things need to be looked at such as slippery walks, loose dogs, and traffic when getting to the patient's home. As you can tell, hospice is a very complex, very necessary service which has many rewards. I hope I have helped you to have a better understanding of this department and the services they provide. In your packet you will find several brochures which you may want to look at in the future. Are there any questions? f:\12000 essays\health & humanities (196)\How Has Aids Affected Our Society.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ How has AIDS affected our Society? Today more Americans are infected with STD's than at any other time in history. The most serious of these diseases is AIDS. Since the first cases were identified in the United States in 1981, AIDS has touched the lives of millions of American families. This deadly disease is unlike any other in modern history. Changes in social behavior can be directly linked to AIDS. Its overall effect on society has been dramatic. It is unknown whether AIDS and HIV existed and killed in the U.S. and North America before the early 1970s. However in the early 1980s, "deaths by opportunistic infections, previously observed mainly in tissue-transplant recipients receiving immunosuppressive therapy", were recognized in otherwise healthy homosexual men. In 1983 French oncologist Luc Montagnier and scientists at the Pasteur Institute in Paris isolated what appeared to be a new human retrovirus from the lymph node of a man at risk for having AIDS. At the same time, scientists working in the laboratory of American research, scientist Robert Gallo at the National Cancer Institute, one of the National Institutes of Health in Bethesda, Maryland, and a group headed by American virologist Jay Levy at the University of California at San Francisco isolated a retrovirus from people with AIDS and from individuals having contact with people with AIDS. All three groups of scientists had isolated what is now known as HIV, the virus that causes AIDS. Lorusso 2 In 1995 HIV was estimated to infect almost 20 million people worldwide, and several million of those people had developed AIDS. The disease is obviously an important social issue. AIDS has caused many to rethink their own social behavior. People are forced to use caution when involving themselves in sexual activity. They must use contraception to avoid the dangers of infection. Many people consider HIV infection and AIDS to be completely preventable because the routes of HIV transmission are so well known. To completely prevent transmission, however, dramatic changes in sexual behavior and drug dependence would have to occur throughout the world. Prevention efforts that promote sexual awareness through open discussion and condom distribution in public schools have been opposed due to fear that these efforts encourage sexual promiscuity among young adults. Similarly, needle-exchange programs have been criticized as promoting drug abuse. Governor Christine Todd Whitman vetoed a bill in New Jersey that tried to create a needle-exchange program. She was accused of being "compassionless". She replied that she could not allow drug addicts to continue to break the law. By distributing needles, she felt that she was, in fact, encouraging them to break the law. Prevention programs that identify HIV-infected individuals and notify their sexual partners, as well as programs that promote HIV testing at the time of marriage or pregnancy, have been criticized for invading personal privacy. Efforts aimed at public awareness have been propelled by community-based organizations, such as Project Inform and Act-Up, that provide current information to HIV-infected individuals and to individuals at risk for infection. Public figures and celebrities who are themselves Lorusso 3 HIV-infected or have died from AIDS-including American basketball player Magic Johnson, American actor Rock Hudson, American diver Greg Louganis, American tennis player Arthur Ashe, and British musician Freddie Mercury-have personalized the disease of AIDS and have thereby helped society come to terms with the enormity of the epidemic. In memory of those people who died from AIDS, especially in the early years of the epidemic, a giant quilt project was initiated in which each panel of the quilt was dedicated to the memory of an individual AIDS death. This quilt has traveled on display from community to community to promote AIDS awareness. The U.S. government has also attempted to assist HIV-infected individuals through legislation and additional community-funding measures. In 1990 HIV-infected people were included in the Americans with Disabilities Act, making discrimination against these individuals for jobs, housing, and other social benefits illegal. Additionally, a community-funding program designed to assist in the daily lives of people living with AIDS was established. This congressional act, the Ryan White Comprehensive AIDS Resources Emergency Act, was named in memory of a young man who contracted HIV through blood products and became a public figure for his courage in fighting the disease and community prejudice. The act is still in place, although continued funding for such social programs is under debate by current legislators. The lack of effective vaccines and antiviral drugs has spurred speculation that the funding for AIDS research is insufficient. Although the actual amount of government funding for AIDS research is large, most of these funds are used for expensive clinical studies to evaluate new Lorusso 4 drugs. Many scientists believe that not enough is known about the basic biology of HIV, and they recommend shifting the emphasis of AIDS research to basic research that could ultimately result in more effective medicines. Most people agree that AIDS is a very important issue and cannot be ignored. Personally, I believe that the country and society is to blame for the spread of AIDS. We let it get out of control. The modes of transmission have been known for a considerable amount of time, yet the disease still continues to spread. There are few people who can honostly claim not to know the ways in which AIDS is transmitted. Similarly, there are very few people who don't know the ways to prevent the spread of AIDS. These methods are very simple and easy to follow. Yet, thousands will be infected this year alone. Another aspect of AIDS that up until very recently was a serious problem is the treatment, or mistreatment, of those who are HIV positive, but do not have AIDS. One of the most famous stories is the treatment of Ryan White. He was not allowed to attend a public school because he had AIDS. His story was told and people began to realize that those with HIV can lead "normal" lives and must be treated equally. Fortunately, conditions have improved. It is hard to know what society might be like had it not been for AIDS. It might be fair to assume that society in general would be much more sexually promiscuous had AIDS not curbed this trend. Another effect that isn't usually noticed at first glance is the creation of jobs. AIDS has made it necessary for thousands of workers in the pharmaceuticals industry as well as research. Also, people have been hired to counsel AIDS patients and write literature about the causes and Lorusso 5 the methods of prevention. Even the arts have changed since AIDS came about. Songs have been written. Movies have been made, such as 'The Band Played On'. In conclusion, the effects of AIDS on society are very far-reaching. They stretch from social behavior changes to a change in art and music. AIDS has caused all Americans to think about their lives and how fragile life is. They must be careful and use caution. Hopefully, all of society will one day know the causes of AIDS and the means of prevention. They will take knowledge and apply it. With a cure and an end to the spread of this disease, society will survive and prosper. Lorusso 6 Bibliography Martelli, Leonard J. and others. When Someone You Know Has AIDS. Crown, 1987. Shilts, Randy. And the Band Played On. St. Martin's, 1987. "Politics, People and the AIDS Epidemic". Weitz, Rose. Life with AIDS. Rutgers, 1991. f:\12000 essays\health & humanities (196)\huntingsons diease.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Huntington's Background Huntington's disease is inherited as an autosomal dominant disease that gives rise to progressive, elective (localized) neural cell death associated with choleric movements (uncontrollable movements of the arms, legs, and face) and dementia. It is one of the more common inherited brain disorders. About 25,000 Americans have it and another 60,000 or so will carry the defective gene and will develop the disorder as they age. Physical deterioration occurs over a period of 10 to 20 years, usually beginning in a person's 30's or 40's. The gene is dominant and thus does not skip generations. Having the gene means a 92 percent chance of getting the disease. The disease is associated with increases in the length of a CAG triplet repeat present in a gene called 'huntington' located on chromosome 4. The classic signs of Huntington disease are progressive chorea, rigidity, and dementia, frequently associated with seizures. Studies & Research Studies were done to determine if somatic mtDNA (mitochondria DNA) mutations might contribute to the neurodegeneration observed in Huntington's disease. Part of the research was to analyze cerebral deletion levels in the temporal and frontal lobes. Research hypothesis: HD patients have significantly higher mtDNA deletionlevels than agematched controls in the frontal and temporal lobes of the cortex. To test the hypothesis, the amount of mtDNA deletion in 22 HD patients brains was examined by serial dilution-polymerase chain reaction (PCR) and compared the results with mtDNA deletion levels in 25 aged matched controls. Brain tissues from three cortical regions were taken during an autopsy (from the 22 HD symptomatic HD patients): frontal lobe, temporal lobe and occipital lobe, and putamen. Molecular analyses were performed on genetic DNA isolated from 200 mg of frozen brain regions as described above. The HD diagnosis was confirmed in patients by PCR amplification of the trinucleotide repeat in the IT 15 gene. One group was screened with primers that included polymorphism and the other was screened without the polymorphism. After heating the reaction to 94 degrees C for 4 minutes, 27 cycles of 1 minute at 94 degreesC and 2 minutes at 67 degrees C, tests were performed. The PCR products were settled on 8% polyacrylamide gels. The mtDNA deletion levels were quantitated relative to the total mtDNA levels by the dilution-PCR method. When the percentage of the mtDNA deletion relative to total mtDNA was used as a marker of mtDNA damage, most regions of the brain accrued a very small amount of mtDNA damage before age 75. Cortical regions accrued 1 to 2% deletion levels between ages 80-90, and the putamen accrued up to 12% of this deletion after age 80. The study presented evidence that HD patients have much higher mtDNA deletionlevels than agematched controls in the frontal and temporal lobes of the cortex. Temporal lobe mtDNA deletion levels were 11 fold higher in HD patients than in controls, whereas the frontal lobe deletion levels were fivefold higher in HD patients than in controls. There was no statistically significant difference in the average mtDNA deletion levels between HD patients and controls in the occipital lobe and the putamen. The increase in mtDNA deletion levels found in HD frontal and temporal lobes suggests that HD patients have an increase mtDNA somatic mutation rate. Could the increased rate be from a direct consequence of the expanded trinucleotide repeat of the HD gene, or is it from an indirect consequence? Whatever the origin of the deletion, these observations are consistent with the hypothesis: That the accumulation of somatic mtDNA mutations erodes the energy capacity of the brain, resulting in the neuronal loss and symptoms when energy output declines below tissue expression thresholds. (Neurology, October 95) Treatments Researchers have identified a key protein that causes the advancement of Huntington's after following up on the discovery two years ago of the gene that causes this disorder. Shortly after the Huntington's gene was identified, researchers found the protein it produces, a larger than normal molecule they called huntingtin that was unlike any protein previously identified. The question that they did not know was what either the healthy huntingtin protein or its aberrant form does in a cell. Recently, a team from Johns Hopkins University found a second protein called HAP-1, that attaches to the huntingtin molecule only in the brain. The characteristics of this second protein has an interesting feature- it binds much more tightly to defective huntingtin than to the healthy from, and it appears that this tightly bound complex causes damage to brain cells. Researchers are hoping to find simple drugs that can weaken this binding, thereby preventing the disease to progress any further. In other Huntington-related research, scientists have found where huntingtin protein is localized in nerve cells, a step closer to discovering its contribution toward Huntington's. A French team reported that they have developed an antibody that attaches itself to the defective protein in Huntington's and four other inherited diseases. This finding may lead to identifying the defects in a variety of others unexplained disorders. The identification of the gene an the huntingtin protein promised to be a major breakthrough in tracing the causes of Huntington's, but that promise has so far been delayed. The protein of Huntington is unlike any other protein known making it difficult for researchers to guess its role in a healthy cell. However, this has not stopped researchers from trying to find a possible cure for HD. Effects on Society By finding possible drugs to weaken the binding of the HAP-1 protein, researchers can provide society an incredibly sophisticated, but quick and easy wasy to screen for new treatments. One of the biggest arguments for genetic testing, even when there isn't any cure or treatment to offer the patient, is financial planning. If you know that you're probably going to be disabled and unable to work before reaching 50, you can plan for it. But what if your income doesn't allow for it? This demonstrates the importance for continuous research on HD. Overview of the Two Articles Both articles concentrate on HD's protein causing affect. There is no doubt between the two that HD is an inherited mutation. The Neurology articles explains how HD patients have much higher deletion levels than agematched controls in the frontal and temporal lobes of the cortex, whereas the article from Times Medical Writer focuses on a possible treatment resulting from a finding of a second protein called HAP-1, that binds itself to the huntingtin molecule only in the brain. Both conclude that HD is a mutation that causes damage to brain cells further in a person's life. f:\12000 essays\health & humanities (196)\Huntingtons disease 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Huntington's Disease Huntington's disease, or Huntngton's chorea, is a genetic disease that causes selective neural cell death, which results in chorea, or irregular, jerking movements of the limbs caused by involuntary muscle contractions, and dementia. It can cause a lack of concentration and depression. It also may cause atrophy of the caudate nucleus, a part of the brain. However, symptoms vary between individuals, with some sufferers showing symptoms that others do not. Those suffering from Huntington's disease normally begin displaying symptoms between the ages of 30 and 50, but has been known to show itself in people as young as two and as old as 80. Huntington's disease is inehrited from one of the victim's parents. Since the gene for HD is dominant, there is a 50% chance of a sufferer's offspring inheriting the disease. Because a victim usually does not begin to display symptoms until after the period in which he or she would have children and the disease may have been misdiagnosed in earlier generations as Parkinson's disease or other similar affliction, he or she might pass along the gene without even knowing it. The gene for Huntington's disease is located on the short arm of chromosome four in cytogenetic band 4p16.3. It was first identified in 1993. While everyone posseses this gene, in someone suffering from Huntington's disease, the number of repeats of a certain trinucleotide, cytozine-adenine-guanine (CAG), is much larger than what it is in a normal person. In an average person, the number of repeats is between 9 and 37. But is a sufferer of HD, the repeat count is from 37 to 86. While nobody has found a direct correlation between the number of repeats and the age when symptoms appear, there is evidence that people with very high numbers of repeats contract the rarer early-onset Huntington's disease, which usually affects people under the age of 20. It is estimated that between .1 and 10 % of people who suffer from Huntington's disease have obtained it through new mutations. There are three different tests for Huntington's disease. The first, presymptomatic testing, is for people who are at risk for the disease. The second, prenatal testing, is a testing of a fetus at risk for the disease. The third type of testing, confirmatory testing, is used on someone suspected of having Huntington's disease. Treatment of Huntington's disease usually involves counciling and education about the disease of both the family and the patient. Since the symptoms are so varied in both type and severeness from patient to patient, medical treatment must be individualized. Depression, a common symptom, is usually treated with tricyclic antidepressants. Those that also show obsessive compulsive behavior may take some types of serotonergic agents. Neuroleptics, or drugs that block dopamine receptors, are useful in the treatment of chorea. It has been suggested that treatment with nerve-growth producing agents may be an affective treatment, but research is still being conducted. Procedures such as pallidotomy, or removing part of the globus pallidus, and thalamotomy, or cutting part of the thalamus have both showed promising results in the treatment of the involuntary movements and tremors in Parkinson's disease and may also help sufferers of Huntington's. Fetal brain tissue transplantation has also helped in Parkinson's disease patients. While there has been a few of these transplantations performed on HD patients, it is still too early to evaluate its success. Since the huntington protien causes a gain of function instead of a loss of function, normal gene therapy tecniques normally do not work. Instead, the protien must be removed or its gain of function effects must be inhibited. Currently, the second approach makes more sense, since we already know how the huntington protein interacts with other proteins and we can, through this knowledge, find modulators to treat the disease. In conclusion, Huntington's disease is a degenerative disease of the mind and body. It ultimately causes death. While current treatments can only help the symptoms, it is hoped that further research and new tecniques will bring about an effective cure. Web Sites Used Baylor College of Medicine- Information on Huntington's Disease http://www.bcm.tmc.edu/neurol/struct/hunting/hunt6.html Huntington's Disease Society of America- Northeast Ohio Chapter http://lkwdpl.org/hdsahome.htm Huntington's Disease Information http://www.lib.uchicago.edu/~rd13/hd/ Caring for People With Huntington's Disease http://www.kumc.edu/hospital/huntingtons f:\12000 essays\health & humanities (196)\Huntingtons Disease.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Huntington's Disease Huntington's Disease is a rare hereditary disorder. It is characterized by irregular movements of the body, slurred speech, and the deterioration of mental functioning. Symptoms of the individual include alternating periods of excitement and depression. It is caused by a buildup of neurotransmitter fluids, which can cause schizophrenia. The first symptoms of the disease usually appear between the ages of 35 and 45, but much earlier and later occurrences are also known. Since this disease occurs later in life, the only chance you would have of being diagnosed with it was if it was in your family's history. If one of the parents of a child has Huntington's Disease and the other does not, the child has a 50% chance of inheriting the disease. Once it is transmitted, it is certain to develop. The disease may progress for 10 to 20 years until the patient dies. No treatment yet exists for this disease. However, in 1983 a U.S. research team announced the discovery of an identifiable segment of DNA that can be used as an indicator of the presence of the gene causing the disease. In March 1993, the journal Cell announced that the Huntington's Disease Collaborative Research Group had discovered the gene behind the disease. This was a major breakthrough in the effort to understand and eventually work toward a treatment of the disorder. Our group has decided to have the child. We have a steady income of $52,000 and are insured through our employers. Our counselor said that it was souly our decision to whether or not we wanted to have a child, but he warned us that the child could have a 50% chance of having the disease. However, he did point out that we were quite young to even be worried about starting a family. We have decided to have children, but possibly at a later time. f:\12000 essays\health & humanities (196)\Hypnosis In Psychology.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Hypnosis in Psychology Throughout the history of this country, hypnosis has been dismissed as a form of gimmickry. Contrary to this, for centuries numerous cultures have used hypnosis as a means of mental and spiritual healing. Hypnosis is defined as an induced trance-like state in which one is highly susceptible to suggestions, or commands. There are three commonly known methods of hypnosis. Two of which, the authoritarian and standardized approaches, are generally considered non-beneficial towards the subject. Meanwhile the utilization approach, primarily developed by Dr. Milton H. Erickson, is the most widely used amongst psychologists today. The authoritarian approach focuses primarily on the power of the hypnotist over his/her subject. The out-dated though still used, standardized approach, is rather limited due to the fact that it considers a person either hypnotizable or not. In contrast to the authoritarian and standardized approaches, the utilization approach, stresses the interaction nature of the hypnotic relationship. These approaches have many dissimilarities and thus are utilized for different practices. The authoritarian approach emphasizes the power of the hypnotist. This approach, spawned by Mesmer and others, is still widely exploited by stage hypnotists and is consequently often the conceptualization held by the uniformed lay person. Even many trained physicians implicitly adhere to this view, which in it's extreme form involves some powerful and charismatic hypnotist exercising some strange power over a hapless and weak-willed subject. In essence, the hypnotist gets the subject to do something he or she wouldn't ordinarily do such as stop smoking or bark like a dog. This approach generally assumes that the unconscious is some passive vehicle into which suggestions are placed. This approach is one which is viewed as limited in value. It is also believed that the unconscious is mistreated or abused. Because of its authoritative manner, this approach is considered ineffective. Many people realized these limitations and subsequently developed what might be called the standardized approach. The standardized approach generally assumes that hypnotic responsiveness is determined by some inherent trait or ability of the subject. There is nothing inherently worn with this approach, especially in a research setting, where sometimes it is required. However it doesn't work very well for allot of subjects, especially those displaying abnormal behavior. The utilization approach assumes that each person is unique in terms of strategies used to create his/her trance and, consequently the hypnotist's effectiveness depends upon how well he/she is able to adapt his/her basic strategies to those of a given subject. Thus standardized methods are not used. The approach further assumes that unconscious processes can operate in an intelligent and creative fashion and that people have stored in their unconscious all the resources necessary to attain this "trance". The question thus becomes: How does the hypnotist bring the subject under trance? Instead of standardized techniques, he/she has to use general principles to guide his/her efforts. There are three defined parts of the utilization approach: 1) accept and utilize the clients reality, 2) pace and lead the subject's behavior and 3) interpret "resistance" as lack of pacing. The first principle-accept and utilize-was stressed again and again by Erickson and is the essential theme of Erickson and Rossi'sHypnotherapy (1979). Briefly stated, accepting means assuming and communicating to the subject that "what you're doing at this point in time is exactly what I'd like you to be doing. It's fine; it's perfect." Utilizing means assuming and communicating the attitude that "what you're doing right now is exactly that which will allow you to do X." The process of accepting and utilizing is one communicating that what the subject is doing is fine and it will allow him/her to do something else (like enter a trance). Bander and Grinder (1975) discussed these principles in the more process-oriented terms of pacing and leading the subject's behavior. Pacing communications essentially feed back the subject's experience; they add nothing new. The major intent is too gain trust from the subject, as well as attention. This enables the subject to be more trustful and cooperative and the hypnotist to be more understanding. Once trust has been gained the hypnotist can lead by introducing behaviors that are different from, but consistent with, the subject's present state and slightly closer to the desired state (e.g.,trance). According to the principle of Ericksonian teachings, the effective hypnotist assumes all experience is valid and utilizable and paces and leads to the desired state. The on thing the hypnotist must remember is that everything the patient is doing, the hypnotist wants him to do. There is no resistance, the hypnotist must adapt to the subject's state of mind, actions and reactions. The three approaches to hypnosis differ in many ways. There is the authoritarian approach, which is used by stage performers and beginners. Also there is the standardized approach which although slightly advanced, still seems to be prejudice towards subjects that are harder to bring into trance. Then Dr. Milton Erickson pioneered the hypnosis of the future. A form of hypnosis that would adapt to everyone. Erickson's approach was far harder on the hypnotist, because it is not learned as a pragmatic routine, it is learned as a a style that each hypnotist develops within himself. This is good and bad in some ways. It is good in that it calls upon the hypnotist's creativity, which is the key to discovering new techniques and approaches. It is bad for the hypnotist who has very little creativity. The standardized approach would be better for hypnotists with little creativity, while the utilization approach would be better for hypnotists with a great deal of creativity. As a society we have looked lowly upon hypnotism as a treatment, and its effects are being lost to stage performers. In my opinion hypnosis offers us a direct path to the unconscious mind; and in the unconscious mind anything is possible. f:\12000 essays\health & humanities (196)\Hypnosis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The British Medical Association and the American Medical Association has called it "a temporary condition of altered attention in the subject that may be induced by another person," (Compton's Multimedia Encyclopedia) but there is still much about hypnosis that is not understood. Because it resembles normal sleep, it was studied and was found that the brain waves of hypnotized people are more similar to the patterns of deep relaxation than anything else. Rather than a psychic or mystical idea, hypnosis is now looked upon as a form of highly focused concentration in which outside influences are ignored. The most known feature of the hypnotic trance is that hypnotized person becomes easily influenced by the suggestions others-usually the hypnotist. They retain their abilities to act and are able to walk, talk, speak, and respond to questions; but their perceptions can be altered or distorted by external suggestions. At the command of the hypnotist, subjects may lose all feeling in a place on the body, and any kind of pain will not cause them any pain. The heartbeat can be slowed or quickened, and a rise in temperature and perspiration can be created. They can be commanded to experience visual or auditory hallucinations or live the past as if it were the present. Also, recently a scientist discovered that the way the subject's mind experiences time can be altered so that hours or even weeks can pass in second, from the subjects point of view. Subjects may forget part or all of the hypnotic experience or recall things that they had forgotten. The hypnotist may also make "posthypnotic suggestions" that are instructions to the subject to respond to a something after awakening. For example, the hypnotist might suggest that, after the subject wakes up he will have an urge to remove his left shoe, and the more the subject resists, the greater the urge to remove it will be, and once it is removed the urge leaves. These suggestions are sometimes used by specialists to repress or suggest away symptoms in a patient such as anxiety, itching, or headaches. Hypnosis is produced essentially by creating a deep relaxation and focused concentration in the subject. They then become mostly unresponsive to ordinary forms of stimulation, and although they are sometimes told to sleep, they are also told to listen and be ready to respond to commands made by the hypnotist. The word sleep is used in hypnosis not to induce actual sleep, but in practice it is understood that sleep is simply the hypnotic trance. The prefix hypno- is named after the Greek god Hypno which means "sleep." In this state they will accept commands, even if the suggestions are illogical. In general, however, subjects cannot be made to do something that conflicts with their moral sense. This is because there are beliefs that are impossible to change, because that person feels so strongly about it, subjects would not be likely to commit murder or robbery even if the instructer told them to do so. There are hypothetically two layers of "morals" that, of course cannot be seen. On the first layer is the morals that were installed throughout the life of the patient. The second layer is generally called the "fixed" morals. The classical methods used to produce hypnosis are usually simple and frequently employ direct commands or monotonous suggestions repeated continuously. Subjects are requested to concentrate on the hypnotist's voice, or they may be asked to concentrate on some object or to concentrate on some repetitive sound. The hypnotist tells the subject over and over again to feel relaxed, or to let his or her eyelids grow heavy and close, to breathe deeply and comfortably, and to go into a deep sleep. The degree of hypnosis is tested by challenging subjects to perform some simple task while suggesting that they cannot do it. For instance, the hypnotist may say, "You will be unable to open your eyes no matter how hard you try, and the more you try, the more tightly they will be closed." The process of induction may take a few hours or a few seconds, depending on how often the subject undergoes it, and also depends on how willing the subject is. Usually, if suggestions are made during hypnosis that it will be easy to induce hypnosis again, the subject will usually enter a trance almost instantly upon an agreed signal from the hypnotist. In conjunction with these induction methods, drugs such as sodium pentothal, alcohol, and certain barbiturates may be used to make the procedure easier, but these are hardly ever necessary and can sometimes even be dangerous. Aside from normal methods, there are a number of specialized techniques used by some psychiatrists to hypnotize their patients. There are a number of other techniques as well-a blow to the side of the neck (a method used by some stage magicians), among others-that are not approved by the medical profession and that can be highly dangerous. Subjects are wakened at the command of the hypnotist, who usually orders them to return to their normal state and suggests that they will feel alert and well afterward. Some subjects may still feel disoriented and drowsy for a period following a trance. In order to produce hypnosis, the hypnotist should have an authority over the subject. Many experts believe that the more the subject believes in the power of the hypnotist, the more readily he or she will give way to hypnotic suggestion. Many factors seem to contribute to hypnotic susceptibility, however, but it is still unclear what these factors are. There is evidence to indicate that a good subject tends not to be anxious, but to be interested in new experiences, imaginative, and intelligent; some research also suggests that hypnotic susceptibility is in part genetically determined. Only 5 or 10 percent of the population can be hypnotized deeply enough to experience the very deepest of the hypnotic trance. This very deep trance is when the border between sleep and extreme hypnosis starts to grow thin. Some of the patients that can go this deep have actually dreamed, while still being fully aware of everything around them. Estimates of susceptibility vary greatly because of the continued disagreement concerning the exact nature of hypnosis. Some authorities claim that anyone is potentially hypnotizable and that failure to induce a hypnotic trance is due to either poor technique on the part of the hypnotist or resistance on the part of the subject. There are also researchers who assert that hypnotism, as it is generally understood, does not exist at all, and thus the question of susceptibility is irrelevant. They believe that hypnosis is not a result of some alteration in the subject's capacities or mental state but is a consequence of "role playing" based upon the subject's preconceptions of how hypnotized persons behave, their expectations, and their willingness to volunteer and eagerness to experience something unusual. When hypnosis first gained the attention of scientists, it was called animal magnetism or mesmerism, after Franz Mesmer of Vienna. In the late 18th century, Mesmer claimed to use it to heal certain ailments. He thought some sort of magnetism was transferred from him to his patients, and that it changed their body fluids. For many years mesmerism was denounced by medical practitioners and generally associated with stage performances and superstition. In the 19th century, before the discovery of anesthetics, physicians started to use mesmerism in surgery. They found that a deeply hypnotized patient would lie perfectly still and appear unaffected by pain, even during operations as serious as an amputation. Around 1840 a doctor named James Braid created the term hypnosis, which means a "nervous sleep." The new name was more acceptable than mesmerism, with its reputation of fraud, and it soon replaced the older term. In the mid- to late 19th century several physicians, including Jean-Martin Charcot and Sigmund Freud, became interested in the use of hypnosis in the practice of medicine. Today hypnosis is widely and successfully used by medical occupations such as surgeons, dentists, and psychotherapists. Physicians may use it to remove anxiety or as an anesthetic. Psychotherapists use it to relax the patient, to reduce resistance to therapy, to help their memory, and even to treat some conditions. Hypnosis is also used in specialized therapies such as those that help a person to stop smoking, eat less, or fight specific fears, such as fear of heights. It is unclear, however, if such procedures have any positive long-term effects. Hypnosis has also been used during police interviews to help the witnesses with their memory. Regardless of the application, hypnosis should be left to those who are properly trained. When used by untrained persons it may have undesirable and even dangerous effects. f:\12000 essays\health & humanities (196)\Hypothesis testing of the observation ablitiesdifferences of.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ INTRODUCTION What is true in the eyes of one, can be seen as a delusion in another. We, as a society, are made up of a dramatically diverse amalgam of cultures and abilities. Finding out what those differences are can help us reach a better understanding of each other, thus a more equitable relationship can be developed. Therefore, finding the observational abilities of a given group may help yield some interesting and valuable information. In the following study several groups were tested on their observational abilities. In order to develop such a test, it was necessary to devise a structured approach for gathering and interpreting the information. Therefore, the scope of the test was formulated based on hypothesis testing. The following hypothesis was established as the criterion for the test: Null hypothesis (Ho) : Males and females do not have different observational abilities Alternative Hypothesis (H1) : Males and females do have different observational abilities EXPERIMENTAL DESIGN The study consisted of 3 groups of varying size and structure. During the initial phase, the members of the study were unaware that any test was being conducted. The locations of the test were Wilford Hall Medical Center : Primary Care Meeting, University of the Incarnate Word : World Literature Class, and University of Texas at San Antonio : Business Statistics Class. The sample sizes and constructs were as follows: Wilford Hall Medical Center : 30 people - 19 (F) 11 (M) University of the Incarnate Word : 19 people - 9 (F) 10 (M) University of Texas at San Antonio: 32 people - 11 (F) 21 (M) The test subjects were all presented with the same scenario, given the normal degree of variation. The procedure of the test was as follows: · The instructor/manager was advised that a test would be conducted sometime during the period. · A male messenger with black hair and wearing a blue shirt and slacks, would enter the room unannounced. · The messenger would hand an envelope to the instructor. · The messenger would then say, "This is from Debbie". · The messenger would then exit the room. The instructor/manager had been asked to wait 10 minutes, then the instructor/manager would pass out a form for the respondents to fill out (Results: Sample Form). All the data was compiled and corrected, then the data was inputted into the SPSS statistical program for analysis. Each correct answer on the form was given a value of 10 and each incorrect answer was given a value of 0. The male and female respondents were analyzed individually by sex and group (Results: Descriptives), Then the relevant scores and data of the groups were evaluated against each other (Results: Observation Test - Mean Scores). RESULTS The following pages contain a sample test and the output of data retrieved from the study. The programs used to evaluate and display the data were the SPSS Professional Statistical Software and Microsoft Excel. SAMPLE TEST FORM Please answer the following questions about the messenger that had previously entered the room. If you do not know the correct response then choose the "unknown" option, please do not guess. Thank You! 1) Was the messenger male or female? › Male › Female › Unknown 2) What color was the messengers clothing? › Red › Black › Tan › Blue › Gray › Unknown 3) What was the messengers hair color? › Blond › Brown › Auburn › Black › Unknown 4) What did the messenger say to the instructor/manager? › How are you today › This is from the Dean › This is a nice day › This is from Debbie › Unknown 5) What did the messenger hand the instructor/manager? › An envelope › A large/thick book › Nothing › A folder › A pen and pencil › Unknown · Upon completion of this evaluation, please return it to the instructor/manager. This has been a study to evaluate the observational abilities of men and women. All information will be for the sole use this study. Thank you for your assistance. CONCLUSION According to the analyzed data from this study, the Ho: Males and Females do not have different observational abilities, would be false. Therefore, the H1: Males and Females do have different observational abilities, would be true. The basis for this conclusion are as follows: · All the mean scores of the female respondents were higher than that of the male respondents. · Individually, the majority of the female respondents answered more of the questions correctly. · Individually, the majority of the male respondents answered more of the questions incorrectly. LIMITATIONS OF THE STUDY In any study it is equally important to understand the limitations, as well as prove the hypothesis. Therefore, it is necessary to outline the potential shortcoming of this study. The primary limitation of this study is the sweeping generalization of observation abilities, based solely on one scenario. In order to develop a more accurate conclusion, many more scenarios and elements would need to be implemented. The element of surprise could also be considered a possible limitation, for the participants may not have been in the frame of mind to be tested. Having only one trial per group and taking into account the small population size, these elements could lend themselves to skewing the results adversely. The element of bias was not a consideration in the overall conclusions. Therefore, several potential bias could enter the study, such as that men may not normally notice personal attire, nor that any degree of attention may be paid to another male. The male may take more notice of a female messenger than that of a male messenger, and vise versa for the female. The test in itself was limited in scope and application. The test was an all or nothing scoring system, not allowing for "coming close". The possibility of visual restrictions of the respondents (i.e. poor sight, color blindness) was not taken into account. Also, the test only had five questions, all of which were very specific, not allowing for further observations. Finally, the groups studied all had some degree of higher education and were all involved in a structured scenario, a classroom or a meeting. Therefore, this may not represent a proper cross-section of the general population. As for the general reliability of the study, it would serve as a good basis for further investigation. Also, it must be taken into account that the developer and administer of the study is not a professionally trained researcher. The study unto itself could not be held to absolute accuracy, nor could it be an integral part of a larger study, rather it would be best utilized as a point of reference. f:\12000 essays\health & humanities (196)\i dunno.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ "We are all murderers and prostitutes-no matter to what culture, society, class, nation one belongs, no matter how normal, moral, or mature, one takes oneself to be." R. D. Laing British psychiatrist. R.D. Laing obviously backs up William Golding's point of view that human nature is evil. Human nature is directly affected by the environment; and is constantly changing due to the experiences of the individual. Oscar Wilde once said "The only thing that one really knows about human nature is that it changes. Change is the one quality we can predicate from it. The systems that fail are those who rely on the permanency of human nature, and not on its growth and development. The error of Louis XIV was that he thought human nature would always be the same. The result of his error was the French Revolution. It was an admirable result." Human nature depends upon the environment in which they are immersed. The idea that children, not humans in general, are swayed by the ideas and actions of their parental figures is also a central idea of the book, "The Lord of the Flies" by William Golding. Because of the war in England where the boys were from their human experience was one of war. If there was no war going on in England at the time they were evacuated from England, there would've been no deaths, no Lord of the Flies, and certainly no beast. Because if they had came with a good human nature then how would there have been a beast which Golding classified as the basic evil inside all of us. Another thing that ties in with this that children try to copy what they see adults do so if a child sees an adult smoke up or drink then he may believe that it is okay or it is right because their parents do it. As George Orwell once said "Part of the reason for the ugliness of adults, in a child's eyes, is that the child is usually looking upwards, and the adults are rarely looking down. Yet no matter what they will always adore, look up to and love their parents." But as was just said sometimes that can be a bad thing. So what must we do? Well for starters why not try to teach our children better and try at all costs to set good examples for our children so that our society will hopefully be salvaged from the god forsaken wrath of evil. Children who's parents smoke have a 40% higher chance of smoking than children who's parents don't smoke.1 Chances are it is a mix of two things, first the fact that they think that it is okay for them to do it since their parents do it, the second is because of the nicotine addiction could be passed on from adults to their offspring. Now of course there are exceptions to the thesis like kids who smoke because their parents don't, but that is usually a small percentile of the population. Most children will not do it as a rebellious act just because they see their parents doing it so therefor it is okay. Now as was stated briefly previously kids will a lot of the time do what their parents do because they look up to them so why wouldn't they copy what the adults are doing. So why can't we just stop altogether because we have a lazy society who rejects change so this may take a lot longer than would be hoped for. "The only thing that one really knows about human nature is that it changes. Change is the one quality we can predicate from it. The systems that fail are those who rely on the permanency of human nature, and not on its growth and development. The error of Louis XIV was that he thought human nature would always be the same. The result of his error was the French Revolution. It was an admirable result." So with this in mind why do people still rely on human nature to remain the same when it has been proven that human nature is constantly changing. That is why our country has not recently had a revolt because our forefathers had enough insight to know that things would not be the same 200 years from then. This idea was shown throughout the book by the kids changing their minds and revolting. First all the children agreed that rules were needed to keep order amongst themselves. Then when they felt the boring and unpleasant side of work and rules they changed their human nature to that of a slacker or a person who doesn't follow society's rules and doesn't attempt to strive for excellence. Also after voting Ralph the president, people still later agreed and followed Jack. So basically al that can be gathered by this information is that never rely on human nature to remain the same. In conclusion, although it may no work due to the constant changing of human nature, we must try not to set bad examples for younger ones who look up to us, and also try to give our children the best life we can provide for them and teach them right from wrong and teach them the right morals. Basically, we should just try to do the best parenting job we can do and hope the information and things you taught him or her will help them through life. f:\12000 essays\health & humanities (196)\Is Salt really harmful .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ As we know, salt is the most useful resource found on earth. In Ancient Rome, salt was used as part of the salary to the soldiers. From this, we can see that salt was as valuable as gold in the past. In our daily life, besides making nutritious food more palatable, salt is very useful in making bakery products, canned and frozen foods. Salt is a good preservative that retards the growth of micro-organisms to make food storage possible for a long period of timie before refrigeration. Recently, an opinion that is harmful to our health was raised by Dr. Arthur Hull Hayes, Jr,. former comissioner of the U.S. Food and Drug Admistration in 1981. The American Heart Dissociation, the American Medical Association also joined the low-salt appeal. They believe that sodium salt is connected with heart disease, circulator disorder, stroke and even early death. By many doctors and researchers are now beginning to feel that salt has gone too far. At the University of Alabama, a short-term research has been done on 150 people on the effect of the intake of salt related to high blood pressure. Result shows that those with normal blood pressure experience no change at all when placed in a extremely low salt diet, or later when salt was introduced, Of the hypertensive subjects, half of those on the low salt diet did experience a drop in blood pressure, which returned to its previous leel when salt was introduced. Of course, these are other researcherswhgich tend to support the findings. A small Indiana study showed that when normal individuals took large amount of salt, the bolld pressure did not consistenly rise into the hypertensive range. Also, study in Israel showed that a low-calorie diet could reduce blood pressure without changing salt consumption. After viewing research statistics, we should know that salt is not exactly harmful to us. In fact, our bodies have a continual need for salt because our bodies need sodium and chloride ions each with a different task. Chloride maintains the balance of water in cells and its environment. It also plays a part of digestion. Sodium assists in regulating the volumn of blood and blood pressure. Also, it facilitates the transmission of nerve impulses and is necessary for heart and muscle contraction. Without this, our bodies could not function properly. On our diets, how much salt is too much?? Medical experts agrees with the daily intake of salt for normal person should be around 4 to 10 grams a day. But those with kidney problem may have to limit dietary salt, if their doctor advises. The cause of hypertension consists of a number of factors. Such as deficiencies in calcium, potassium and obesity. In conclusion, salt restriction may harm more people than it helps. Unless your doctor has proven that you have a salt related health problem, there is no reason to give salt up!! f:\12000 essays\health & humanities (196)\Lancelot.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ "Let love be without hypocrisy. Abhor what is evil; cling to what is good (Romans 12:9)." This principal seems to be markedly evident as one closely examines the actions and thoughts behind the character of Sir Lancelot in The Knight of the Cart. When one encounters the adventures of Odysseus in The Odyssey, however, the values of a completely different and slightly opposing culture present themselves. In the medieval times of Sir Lancelot, an ideal man would tend to follow the teachings of the Bible and live a relatively mild-mannered life. On the other hand, in the culture of the Ancient Greeks, the "perfect" role-model for life would be Odysseus and his perspicacious adventures involving grandiose plots against him and his crew. The ideals exemplified by Lancelot and Odysseus greatly and eloquently reflect the morals and aspirations evident in the literature of their respective time periods. This idea is demonstrated when one examines the similarities between Lancelot and Odysseus, their differences, and the consequences of their actions on their lives. Although Lancelot and Odysseus lived in completely different and somewhat opposing time periods, their heroic and "larger than life" personalities share some quite distinguishing characteristics. I say that their time periods were somewhat opposing because the views of the culture regarding the afterlife and any supernatural occurrence represent the conflict present between monotheism and polytheism. One mutual characteristic of Lancelot and Odysseus is their physical prowess present when they do battle against anyone opposing their divine quest. Odysseus tends to take a more militaristic and pitiless attitude toward this combat as shown during his battle with the suitors. Not only does Odysseus slay the entire lot of suitors, but he kills any servant or maid that has been unfaithful to him in his absence. Lancelot, on the other hand, pursues his ultimate goal with an undying diligence while trying, more often than not, to take pity on the individuals that he must combat. This is best demonstrated in The Knight of the Cart when Lancelot fights the knight that repeatedly taunts him about riding in the cart. Although he initially shows this knight mercy by giving him another chance to fight against him, this compassion is revoked as Lancelot wins for a second time and beheads the knight. Lancelot reveals, by this action, a desire to be just to all; he wants to be generous to the girl while showing compassion to the defeated knight. Another shared feature in the personalities of Lancelot and Odysseus is their interminable desire to follow through on their quest to which they have devoted a large portion of their lives. Even though, in the case of Odysseus, this quest is not one that is embarked upon voluntarily, he pursues it with a passion so rich and intense that it can hardly go unnoticed to the attentive reader. This is also the case with Lancelot and his continuous efforts at attaining the fleetlingly elusive love of Guinevere. This is illustrated at the numerous points in the story when Lancelot sacrifices himself or his own needs to satiate those of the queen. This passion shared by both Lancelot and Odysseus is a common thread between the two and represents at least one similarity between the viewpoints of the Greeks and the medieval Europeans. The cultures of the medieval Europeans and the Greeks do, in fact, share many similarities; however as one probes deeper into the characters represented in their literature, it usually appears that the converse is true. Although both men represent the heroic ideal, this ideal is quite different to Greek society than it was in the twelfth-century Europe. For instance, the way that the hero views himself varies exceptionally between the two cultures. Odysseus commits the terrible sin of hubris on numerous occasions in The Odyssey. For instance, when Odysseus and his crew must pass the sirens to return to Ithaca, Odysseus insists that he be tied to the front of the boat with his ears plugged so he can accomplish the feat that no other man before him could do. The opposite is true for Lancelot as is evident at numerous points in the story. One example of Lancelot's selflessness is during the contest when Guinevere tells him to do his worst. Because of Lancelot's devotion to his love and her every word, he deliberately embarrasses himself in every event to prove his undying faithfulness. The issue of loyalty is another pronounced difference in the characters of Odysseus of Lancelot. To Odysseus, loyalty apparently did not mean faithfulness to his loving and persevering wife, Penelope. This is shown when Odysseus has sex with Calypso and Circe obviously for his own pleasure and in no way for the sake of his wife. On the other hand, Lancelot agrees to sleep with the girl who offers him lodging only after pleading with her not to make him sleep with her. He did this not because the girl was unattractive for he states, "Many men would have thanked her five hundred times for such an offer (219)." He agrees to this act only because he believes that he needs the lodging to rest himself so he can dutifully continue his quest for Guinevere. The cause of this difference between Lancelot and Odysseus apparently goes much deeper than the surface actions of the characters. This idea rests on the individual principals of the two men and how they see themselves in relation to others around them. Odysseus sees himself as better than other men while Lancelot tends to take a more humble attitude much like that of Christ. These attitudes, I believe, represent the viewpoints or ideals held by the general people during the time periods of these two men. One effective mean of judging the actions of a person is by looking at the consequences or results of the actions after which that person has chosen to model his or her life. For both Lancelot and Odysseus, the actions they choose lead to their ultimate goal, but the effects along the way are quite different. In the case of Odysseus, his numerous trespasses against Poseidon cause a considerable amount of hardships against him and his crew. For instance, every time the ships of Odysseus approach Ithaca, Poseidon, either directly or indirectly, manages to reroute their course to a place much less desirable. Another aspect worth mentioning is the vicious cycle in which Odysseus seems to be caught at the end of the epic. The family of Antinous seeks revenge for his death and Zeus is the only one, in the end, who can stop this cycle. When the events that occur in the adventures of Lancelot are closely analyzed, however, there seems to appear a substantially happier existence. Lancelot is so overjoyed at one point in the story that he slices his hands on the iron bars attempting to reach Guinevere and does not even realize his own lacerations. He also, throughout his adventures, tries to the best of his ability to live a life like Christ. Even though some might argue that Christ would hardly kill another man, I believe that Lancelot, like every man since the dawn of time, has flaws that are inherent, due to the original sin of Adam and Eve, and does the best that he can to live up to the standards set by his role-model, Jesus Christ. In addition, Lancelot, at the end of the story, retains his dignity as an upstanding man that possesses all of the above described qualities. Although this can be said, to some extent, about Odysseus, he would not be judged by the standards we hold today to be an upstanding man of moral integrity. This is not to say that we should enforce the ideals and values that we hold as a culture down upon a civilization that did not live by the same values that we do today. It is only to state that the actions of these characters reflect the natural laws that are always present around us; therefore, the consequences or rewards of life reflect those actions. The literature produced by both the medieval Europeans and the ancient Greeks provides an informative glance into the ethics and archetypical standards by which they lived. The literature in the time of Odysseus presents the heroic ideal as one of extreme physical prowess but seems to be relentless in his constant pursuit of those who wrong him or are in any way unjust to him and his family. When one looks at The Knight of the Cart, Lancelot appears to have this same brawn; however Lancelot generally restrains himself and at least tries to look compassionately at those with whom he must do combat. Although each of these time periods is quite different from the other in many ways, this is not to say that one culture has supremacy over the other or is any more valuable to the Western thought of today. Each civilization has donated much which governs the way we think today and should be regarded with the utmost respect as a truly great culture. f:\12000 essays\health & humanities (196)\lead poisoning.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Effects of Lead Poison on Children Throughout the world today one out of every six children under the age of six are suffering from health disorders due to a poisonous metal known as lead(Kiwanis, 1996). Lead is a natural occurring bluish-grey metal found in the earth's crust. It has no taste or smell. Lead can easily be found in all parts of our environment today. Most of it comes from mining, manufacturing, and last but not least the burning of fossil fuels(Xintaras, 1993). In the United States lead poison has increased because of the lack of knowledge in our society. (Background information on the effect's lead poison has on children) Lead is released into the environment by industries, the burning of fossil fuels or wastes. When lead enters the environment, it starts to become a problem. After a period of about ten days, depending on the weather, it falls to the surface. Here lead builds up in the soil particles. Where it may make its way into underground water or drinking water due to the fact the grounds acidic or if it's soft enough. Either way it stays a long time on the soil or in water. Months or years down the road after the lead has built up it starts to become a problem for children that play outside of their homes (Xintaras, 1993). These lead containing soil particles get on the child's hands or clothing and end up in the child's mouth. After the build up of so much lead it leads to a problem commonly known as lead poison. Lead poisoning has been an issue since the early 1900s, when the use of lead started being banned from the manufacturing of paint in foreign countries such as Australia(Monheit, 1996). Unfortunately the United States did not start banding it until 1978, when it finally became illegal in our nation. Today 90% of the lead in the atmosphere comes from the burning of gasoline. This problem has been a large issue since the 1920s, when the EPA(Environmental Protection Agency) started making laws on the amount of lead allowed in gasoline. There are many other ways that a child especially under the age of six can be diagnosed to lead poison besides air pollution. One of the most common ways of our past is when a child eats or chews on an object that has lead based paint chips in or on its surface. Parents can easily prevent this from happening by reading labels or buying objects which are not painted. Another way in a child can be affected is by drinking water that comes from lead pipes. Houses built prior to 1978 have been found very unsafe due to the older pipes(Verstraaten, 1997). These pipes can be easily replaced in most situations. This process may be expensive but it pays off dearly when it comes to your family, and never let your child drink from a water fountain or a water hose that you are not sure is safe(Reducing Lead Hazards When Remodeling Your Home, 1994). The build up of lead in the soils another problem. Bare soil can easily contain lead from car exhaust, paint peeling, and near by industries pollution. The easiest way to prevent this is by not letting you child play on bare soil or cover the soil before letting the child play in the area(Handout IIa: Activities to Reduce Environmental Exposure, 1997). Breathing workplace air has been a problem in past also. When parents are not aware of the near by power plants or industries, which could be letting off lead into the air. It can lead to problems. So its always best that you know the area really well that you child is playing in. Another incident that occurred here recently in North Carolina was a young child was discovered having lead poison after eating some pool-cue chalk. Researchers here found the cue chalk could actually be a source of environmental lead(Modica 1996). There are many effects or symptom that lead poison can have on a child if diagnosed at an early age. These injuries our so severe because the body and the brain are not fully developed, which can leave children with subtle but irreversible injuries that does not appear until many years after the exposure of lead(Monheit, 1). In young children, lead retards the development of the central nervous system and brain. Lower levels of lead can reduce their IQ, reading and learning disabilities, attention deficit disorder and behavior problems. When these are added up it causes the student to become a dropout from school and a negative contribution to our communities(Monheit, 1996). The United States Centers for Disease Control and Prevention in Atlanta (CDC) have found that these injuries occur when blood levels rise to a mere 10 Micrograms per deciliter of whole blood. Lead poisoning is treatable in the early stages due to the great amount of investigation that the medical and environmental fields have put forth, but the damage that the lead does in a child's body is not treatable, so once the lead has been damaged, its permanent (Monheit, 1996). The CDC also asks parents to make sure that their child receives a blood-lead test at each pediatric checkup at least until the age of seven. If any of the following symptoms, are obtained by any child consult to immediate emergency care: sluggish behavior, apathy headaches staring periods, tremors, seizures, loss of consciousness abdomen cramps, loss of appetite, constipation irritability hyperactive behavior All of the following symptoms are early stages of lead poisoning and if not treated when possible the symptoms of this poisoning may lead to a child being put into a coma or even death. (Ways that people can stay informed on lead poison) Information on lead poison today is so easy to get access of. One of the easiest sources of information can be found on the Internet. Many people still do not yet realize how much information it releases. I found that this subject had thousands of documents over the Internet that could be easily reached by the touch of a few keys. Examples of this is: Preventing lead poisoning by the Kiwanis International, Lead Paint Poisoning of Children by the Law Offices of Herbert Monheit, and Lead by ToxFAQs. Besides the Internet they're other tools that can easily be obtained such as Ebsco Host. This is a program in which one can find information in periodacles over a computer. It saves a lot of time because one doesn't have to go to a library and look through periodicals that can take hours. Being this was my first time exploring this program I found many valuable keys of information in it such as: Preventing Childhood Poisoning, the FDA Consumer, which explains the steps that the FDA are taking in order to stay informed on lead and lead poisoning. Lead in Homes Subject to Additional Disclosure by Business Journal of Charlotte magazine. This magazine tells about the new federal regulations on lead-based paint in 1996. If one doesn't have access of either of these programs most libraries have many books and periodicals that cover this subject. Other programs that stay informed on this issue can be found governmental agencies such as the Alliance to End Childhood Lead Poisoning, located in Washington D.C.. This Alliance staff offers technical assistance and will help clubs find local contacts who can offer expert advice for local preventing program. Materials and requests are also found through the Alliance. Examples of this is: Guide to State Lead Screening Laws, Resource Guide for Financing, Lead-Based Paint Cleanup, and copies of fact-filled articles from news papers, magazines, and other organizations. Another governmental agency which seems to be on top of this subject is The Environmental Protection Agency. They make the law and requirements on lead in our environment today. The Lead Institute of San Francisco offers free pamphlet on lead poisoning and sells testing kits and books on lead poisoning. Another is the National Lead Information Center/Hotline located in Washington, D.C. has a variety of brochures and facts sheets aimed at Parents and explaining the dangers of lead poisoning, the importance of testing children, and safe home renovations(Kiwanis International, 1996). In Chicago Illinois the Films Incorporated Video is a programs that obtain video tape and study guides tilted for the awareness of kids in lead hazard areas. These developed films by Consumers Reports Television and Connecticut Public Television can be purchased for a small price(Kiwanis International, 1996). The broadcast media doesn't play a big role on lead poisoning unless an incident comes along which turns out to affect a large number of people or an important individual. If one needs to stay informed on this information over a sustained period of time, I would direct them to the Internet, because its filled with so many resources and its always up dating its information on a daily bases. (Encouraging Governmental Actions) The government has many actions to protect human health. One of the leading agencies in this field is the Environmental Protection Agency. The EPA began in 1970 with the passage of landmark legislation. Much has been accomplished it those 27 years, but much remains to be done. Due to the learning and failure of the EPA an extensive study entitled Reinventing Environmental Regulations took place on March 16, 1995, the study makes several important points: Americans are committed to a healthy environment. Pollution is a sign of economic inefficiency. Profits can be improved by preventing pollution. Better decisions result from collaborative processes than adversarial ones. Regulations allowing flexibility can provide greater protection at lower cost. (Hankinson,1996) These regulations would probably not of taken place if it was not up to the regional administrator for Region IV of the United States, John H. Hankinson Jr. (Hankinson, 1996). Today the EPA limits the amount of lead that can be in leaded gasoline to 0.1 grams of lead per gallon of gasoline(0.1g/gal), and unleaded gasoline to 0.05g/gal. The amount lead in the air is required under 1.5 micrograms per cubic meter average over three month period, and lead in drinking water to 15 micrograms per liter (Xintaras, 1993). If help is needed the EPA works with several different agencies such as: Occupational Safety and Health Administration that can be reached by this Number (202) 219-8151, the National Conference of State Legislatures at (303) 830-2200, and the National Lead Information Center Clearinghouse at (800) 424-LEAD. The Food & Drug Administration(FDA) is one of the oldest protection agencies in our nation today. The FDA is a public health agency, charged with protecting American consumers by enforcing the Federal Food, Drug, and Cosmetic Act and several related public health laws. Today the FDA is located in 157 cities across the country. It investigates and inspects around 95,000 FDA-regulated businesses(The Food and Drug Administration, 1995). This organization is taken steps to protect children from lead poisoning by proposing regulations that will make it harder for small children to gain access to high-potency lead products. FDA is also helping ensure that health-care providers and consumers are alerted to the dangers associated with accidental overdoses of lead-containing products (Hingley, 1996). Today the FDA is headed by the Commissioner David A. Kessler, M.D. Government officials face many key arguments or points each day. One argument that I would encourage governmental official to look at is the amount of lead allowed in gasoline. Today the burning of leaded gasoline is the number one pollution dealing with lead. So in my opinion I would suggest that they reduce the amount of lead in gasoline so that are children and the following generations do not have to deal with this problem. Another point is what is the government and their agencies doing in order prevent this pollution from causing problems in our future. (Supporting non-governmental Organizations) Besides governmental organization there are organizations that work throughout different communities that try too help people that are in need. One example of this is the Program Development Department Kiwanis International. This organization has a few goals it would like their communities to know about: 1. Awareness of the risk of lead poisoning and particularly the danger in home renovations. 2. Identification of Children who are at risk of who are already poisoned. 3. Removal and reduction of the lead hazard in hones, child care centers, and schools. They ask if there any questions about any of these goals or anything about preventing lead poison to contact them at: Program Development Department Kiwanis International 3636 Wooodview Trace Indianapolis, IN 46268-3196 U.S.A. 317/875-8755, ext.214 800/549-2647 (North America Only) (Kiwanis International, 1996) (Steps that I can Personally take to Make a Difference) Besides governmental and non-governmental organizations there are steps that we can make in our communities that will help out. One step that I would personally take is by letting my friends and family know some of the facts on lead poison such as: 1. Where not to let there children play 2. Toys children should not play with 3. Items that one should not bye due to high amounts of lead This would help them keep their homes in a condition which would be safer for there children. These steps may take a little time and money but the outcome will help ensure a cleaner environment for the next generation. References 1. Anon. Preventing Lead Poison. (1996). Kiwanis International. http://www.kiwanis.org/po16.htm. 2. Verstraaten, John. Lead Inspection. (1997). Environmental Concepts Inc. http://www.gate./~verstraa/lead.htm. 3. Anon. An Overview. (1995). The Food and Drug Administration. http://.fda.gov/opacom/hpview.html 4. Xintaras, Charlie. Lead. (1993). ToxFAQs. http://atsdr1.cdc.gov:8080/tfacrs13.html. 5. Modica, Peter. Pool-cue Chalk Can Cause Lead. (1996). Medical Tribune News Service. http://nytsyn.com/live/Childcare/193_071196_193431_3200.html 6. Anon. Reducing Lead Hazards When Remodeling Your Home. (1994). Environmental Protection Agency. 7. Monheit, Herbert. Lead Paint Poisoning of Children. (1996). Law Offices of Herbert Monheit. http://www.civilrights.com/leadpaint.html. 8. Hankinson, John. Reinventing Environmental Protection:EPA's View. South Carolina Business Journal. (1996) f:\12000 essays\health & humanities (196)\Leukemia.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Leukemia is a cancer that has had a significant effect on our society and with the developments of new drugs it may become treatable. Leukemia originates in the blood-forming organs which may include the lymph tissue and bone cells. In a person with leukemia the rate and the number of cells produced is altered. This altering can become fatal, or with proper treatment it can be subdued. There are two main types of leukemia which include ³total² and ³differential.² These are mainly characterized by the appearance of white blood cells. When leukemia attacks the blood cells, the bone marrow (where blood cells are made), the spleen, and the lymph nodes are extremely weakened (Reagan 90). The classification of leukemia is based on what organ it is attacking. Leukemia can be in acute or chronic form, which means it can happen rapidly, or be prolonged and severe (Bourne 996). To diagnose leukemia doctors have to insert a needle into the bone marrow to extract it and then then view it under a microscope to see if it has any abnormalities that relate to that of leukemia. Some of the symptoms that are involved with leukemia include: lack of energy, fever, susceptibility to infection (because of lack of white blood cells), excessive or repetitive bleeding, easy bruising, and also enlargement of the liver, spleen and lymph nodes (997). This disease has been known to cause about ³10% of all cancer deaths, about 50% of all cancer deaths in children and adults less than 30 years old, and at least 4 million people now living are expected to die from these forms of cancer (Reagan 1).² Over half of every type of leukemia occurs in people over the age of 60. Even though so many people have been getting different types of leukemia, the causes are not totally known. There is evidence that exposure to radiation can reduce the development of leukemia. Also, a genetic inheritance has been shown to be a factor in the incidences of leukemia and sometimes it is seen accompanying birth defects (Altman and Sarg 154). With the problems that surround leukemia and the probability of death there are ways to treat it. Most of these treatments have only developed recently and are still undergoing testing. But a few drugs have been shown to produce a state in which the patients shows no sign of cancer. One of these drugs is 2-chlorodeoxyadenosine, which kills the bad white blood cells, but leaves the good. ³In 1990...patients treated with this new drug for just one week were in complete long-term remission (Weaver 29).² This long-term could very probably last forever until the patient dies and the leukemia reappears again. Another drug called DCF, when tested on patients, ³brought about complete remission in 104 of a 152 of them (Fackelmann 363).² Other researchers also noted that they would have to wait over 10 years to know for sure if the patients would have a relapse (363). In addition to these drugs, many other powerful drugs are used to remedy leukemia and, chemotherapy is also a treatment. The two drugs mentioned before remain to be presently the closest thing to a cure for all types of leukemia. In conclusion, leukemia is a cancer that has affected many people¹s lives and remains to be a frightening disorder that we have to deal with in the medical world. Fortunately, it looks like a hopeful future with the developments of new drugs. Maybe, with the increase in technology and new medicines we may someday surpass present day treatments and find a complete cure for leukemia. Bibliography Altman, Robert and Michael Sarg. The Cancer Dictionary. NY: Facts on File Co., 1992: 153-155. Bourne, Sarah. ³Leukemia.² Marshal Cavendish. NY: Marshal Cavendish, 1993: 996-998. Fackelmann, Kathy A. ³New Treatments For Hairy Cell Leukemia.² Science News 30 May 1992: 363. Reagan, Reginold. ³Leukemia.² The Grolier Electronic Encyclopedia. 1990 ed.: 1. Weaver, Daniel. ³The Secret In The Marrow.² Discover. January 1994: 26-29. f:\12000 essays\health & humanities (196)\Lie cheat and steal.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Todays society is a dangerous and corrupt place. People would lie , cheat , and steal just to make a dollar. People are even taking there parents to court these days . How ludicrous can a person get ? A person would sue a tobacco company because they had developed cancer . This is outrageous ! For one reason , how could a person just pick on one company in particular . Because of the fact that a person could not smoke just one brand of cigarette . Now if that isn't money Hungry I don't know what is. The consumer is at fault for buying and using the product anyway. On the package of cigarettes it states that the surgeon general warns everyone of the harmful effects that cigarette can cause. The case does state that the cigarette can cause cancer, emphysema, and also lung cancer. Even if the reader is illiterate it still shouldn't matter .The information on the boxes gets around by word of mouth . Second of all , it's no one else's fault for them smoking . The smoker, picks up the cigarette,light it up ,and puff. Also the cigarette doesn't just jump in your mouth . Anyone who would try to sue a cigarette company should be put away , because they are most definitly insane. I am a smoker , but I still can't understand why any person would do that . It saddens me to know that people would sink so low just to get some money. The world is getting worse everyday.Maybe someday we'll realize that with out each and every one of us working together the earth wouldn't have any thing left. f:\12000 essays\health & humanities (196)\Living Will.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ THE STORY Imagine someone you love...better yet, imagine yourself lying in a hospital bed oblivious to the world around you, unable to move or show any signs of life, your own existence controlled by an I.V., a respiratory machine, and a feeding tube. In essence you are dead. Your body is no longer able to sustain life, its entire purpose is now replaced by a machine - you are being kept alive by artificial means. At this point the question arises - should you be kept alive by these means or should you be allowed to die a natural death? Unfortunately you are unable to answer this question because your voice is limited to a "beep" on a heart monitor machine. Who then is going to decide if you live artificially or die naturally? Who gets to play God? Well, if your family doesn't have your written consent in the form of a living will, to cease life support, then the doctor will make the ultimate decision for both you and your family. Most often this is the case. Even though writing a living will is just as easy if not easier than writing a death will, many people don't take the time to do so. Therefore, doctors have to debate the question of euthanasia - a question that each one of us should ponder long before we are put in this situation. What is euthanasia? Euthanasia is not mercy killing. It has absolutely nothing to do with killing. On the contrary, euthanasia by definition simply means "good death" and in the applied sense it refers to "the patients own natural death without prolonging their dying process unduly." What this attempts to accomplish is to allow a person to die with peace and dignity. In most cases life-support systems simply prolong the terminal suffering of a patient by a few more weeks or months, they do nothing to return a patient to a normal functioning human being. With most terminally ill patients life support does not mean prolonging life - it means prolonging suffering, for both the patient and their family. Although there are no statutes legalizing euthanasia in the U.S. many doctors end a terminal patients life by administering a fatal dose of a drug that they were previously administering. Furthermore, most hospitals knowing that there is little or no hope for a terminal patient, provide less than adequate attention and care to them. A living will makes the possibility of this entire situation virtually non-existent. A living will is the patient's written request not the doctor's decision, not to be placed on life-support systems, and this request must be honored by the doctor. Just as property is proportionated to those named in a person's death will, so must their requests be recognized in a living will. If a person has a living will written then if it is so stated, they will not be placed on life-support. Instead, they will either stay in the hospital or be sent home so that their body will be allowed to take the natural course it has begun. If a body, nature, God, or who-be-it, has decided that it is a person's "time" then who are we to say that it isn't? Obviously, we are in neither a spiritual nor a moral position to make this decision. Therefore, we should not implement artificial life-support methods to either prevent or delay the body's natural degenerative process. Instead, we should face and overcome our own fears and internal conflicts with death. And one way to do this is by writing a living will. Living wills help medical staff and others to make decisions about your care and treatment should you become seriously ill and unable to speak for yourself. In some circumstances, living wills may become legally binding on health care staff. Living wills are considered clear and convincing evidence of a person's preferences for end-of-life treatment (see attached forms). MEDICAL BACKGROUND From the advent of medicine the ultimate goal for physicians was to maintain life. The death of a patient became a sign of a physician's defeat, the prolonging of life a sign of his or her ability. Although this philosophy still continues new variables were added to the equation in the 1960s. During this decade modern technology began to produce machines such a lung and heart machines capable of taking over normal body functions for long periods of time. These machines were intended for temporary use until the normal organ function could be restored and the patient could return to normal life. But the machines also created two problems. First, because prolonging life became an end in itself, some physicians employed these machines even in situations in which there was no hope of the patient ever returning to a meaningful life. Second, even those physicians who avoided unwarranted use of the machines found that emergency circumstances often required the immediate use of such machines when the doctors were unable to determine the potential for a return to meaningful life. When time proved the patient would not get better, the machines, already in use, were difficult to disconnect. LEGAL BACKGROUND The case the brought attention to the need for Living Wills occurred in 1976. Karen Quinlan, a young woman whose brain had been severely injured leaving her in a coma, had been maintained on an artificial respirator for one year. Her parents asked a judge of the New Jersey court to allow them to order her respirator removed. Amid media headlines and passionate debate across the country, the New Jersey Supreme Court ruled that Karen Quinlan was unable to comprehend her situation or have a voice in the decision. The court allowed her parents, as her closest living relatives, to make the decision for her. Thus began the evolution of the modern legal concept of the right of self-determination in health care. THE BOTTOM LINE Even though most of us try to avoid the fact that we are going to die, it is an inevitable fact and we must all plan for the future abidingly. Therefore, each and everyone of us should seriously consider writing a living will. By doing so you will minimize both the financial and the mental pain and suffering both you and your families may encounter. Furthermore, you will ensure that you and not your doctor makes the most important decision of your life - whether or not to die. Unfortunately, death is a part of life and just as we strive to live with honor, we must also strive to die with dignity. f:\12000 essays\health & humanities (196)\Lucid dreams.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Lucid Dreams: the First Virtual Reality Psychological Sean Pasinsky LibEd 316-2 5 Feb. 1997 For ages people have thought of dreams as curses or blessings that we could not prevent nor manipulate. This "place" called our dreams has constantly puzzled us, because it is here where all things are possible and seem to occur. In our dreams we perform superhuman and wonderful feats that would normally be impossible in the "awake world". We find the men or women of our dreams, depending on our sexual orientation. While we dream, these wonderful things become our temporary reality. Yet sometimes while dreaming we may experience the most horrifying events imaginable, called nightmares. Everyone has their own version of horror, my most terrifying nightmare has been where my family and friends have been taken control of by evil monsters that cannot be stopped. Rather than kill me they make me watch old 1970's television shows over and over. For years, men have thought that there should be a way of preventing or controlling these nightly events. Humans must, like any animal, sleep. We do not fully understand why we must sleep. We only know that if we are deprived of sleep long enough that we will most certainly die. The same is true for dreams and dreaming(1). If we sleep long enough we will reach an advanced stage of sleep where our body begins to experience rapid eye movement (REM). It is during this REM period that we experience most of our dreams. Many scientists try to speculate the reasons for dreaming through biological our psychological means. This proves to be very frustrating for someone trying to find empirical meaning and truth about his or her dreams. There are countless books written about dreams with just as many different interpretations and meanings for specific dream references. For psychics, astrologists, or psychologists who attempt to interpret dreams, there are numerous factors that must be considered when endeavoring to find meaning in a dream. Because of these numerous factors that contribute to the condition of dreaming, many different paths have been created for exploration. From Freud's sexual symbolism to the current random recollection theories diversity in dream interpretation abounds. However, there is a way to dream and not be at the mercy of your subconscious mind. For the past ten years a bright psychologist at Stanford University, by the name of Steven Laberge, has been studying dreams and the physiology of the human body during the dream state. His research may sound commonplace if it weren't for the added fact that he is training people to control their dreams. His subjects are learning to become aware of their dream experience as it is happening. Once they are aware of their dream they can simply take complete command of their dream and can consciously cause anything to happen. To the semi-conscious mind the experience is virtually identical to being awake. This concept is nothing new, in fact many of us will experience at least one of these dreams in our lifetime. There are a variety of stimuli that he uses to induce this state of mind. One method is playing a tape recording of the phrase "This is a dream" during the sleeper's REM. He may also use conditioned tactile stimuli. Light, however, appears to be the best stimulus means of providing an external cue to the sleeper that they are dreaming. This is because environmental light seems to be easily incorporated into dreams and, when properly conditioned, reminds dreamers that they are dreaming(6). Use of a special light device has been promising: 55% of 44 subjects had at least one lucid dream during one study(5). The possibilities for human progression that this concept creates seem to have no bounds. For years psychologists and others have sought to find a perfect semi-conscious state of mind where a subject will have a strong link with their subconscious and may even interact with an interviewer using this frame of mind. Another name for this state of mind is called hypnosis. Although the "lucid" state of mind that Dr. Laberge's patients experience is not completely conscious or subconscious, they are still asleep, and the world that they are in is very detailed and just as realistic as our waking world. That is what puzzles most people who look into his research. Although not mentioned by Dr. Laberge in his studies, I think that there is a definite opportunity for a great unlocking of the secrets of the human mind. Many practical applications exist for lucid dreaming. There are of course the obvious, nightmare therapy, self-confidence enhancing, and general mental health improvements, but there are so many more ideas not yet explored. Some of these may include depression therapy for physically handicapped people allowing them a very real sort of fantasy fulfillment. Paralytics can walk, dance, fly, or do as they wish sexually whenever they choose. The possibilities for creative problem solving seem to be obviously enhanced. There even seems to be a great amount of possible sensorimotor practice that could possibly be used by stroke or other nerve damaged patients. And finally to quote Dr. Laberge(1), "lucid dreaming can function as a "world simulator." Just as a flight simulator allows people to learn to fly in a safe environment, lucid dreaming could allow people to learn to live in any imaginable world; to experience and better choose among various possible futures." What makes humans extraordinary in the animal kingdom is our awareness of being. It is an awareness of our life and existence coupled with our advanced capacity to reason that makes us different than the other animals of the Earth. I believe that it may not only be our awareness of thought, but the exact capability of being aware somehow of our subconscious motivations. A strong sense of our subconscious can be obtained in a state of sleep where the sleeper is fully aware not only that he or she is dreaming, but that he or she is actually sleeping. Humans can now do this regularly without any type of influencing hypnotic suggestion given by a hypnotist. This state of mind seems to be more powerful than any kind of hypnosis, even self-hypnosis. I believe that somewhere locked inside our minds is an empirical understanding of our existence not just an awareness. REFERENCES 1. LaBerge, S.(1985). Lucid dreaming. Los Angeles: J. P. Tarcher. 2. LaBerge, S. & Rheingold, H. (1990). Exploring the world of lucid dreaming. New York: Ballantine. 3. Llinas, R. & Pare, D. (1991). Of dreaming and wakefulness. Neuroscience. 4. Watson, J. (1928). The ways of behaviorism. New York: Harper. 5. LaBerge, S., Kahan, T. & Levitan, L. (1995). Cognition in dreaming and waking. Sleep Research, 24A, 239. 6. LaBerge, S. (1990). Lucid dreaming: Psychophysiological studies of consciousness during REM sleep. In R.R. Bootsen, J.F. Kihlstrom, & D.L. Schacter (Eds.), Sleep and Cognition. Washington, D.C.: American Psychological Association (pp. 109-126). f:\12000 essays\health & humanities (196)\MAC Cosmetics.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ MAC Cosmetics Make-up Art Cosmetics, also known as M.A.C. cosmetics is a highly unique corporation. Its founders and business strategies are rather simple yet extremely effective in contributing to the companies success. The company does not use any fancy business schemes and it is truly concerned with its consumers. In the beginning, the company struggled to get started, but now a multimillion dollar (and still growing) enterprise, M.A.C. probably has some of the most popular and most demanded for cosmetics available in the market. M.A.C. Cosmetics is a dynamic company which produces skin and hair care, beauty products, and cosmetics, created for everyone. Rich and poor, old or young, conservative or trendy and even for males or females. Sales for M.A.C. are growing rapidly. From 1985 ($600 000) to 1989 ($3 million), sales were steady. Then in 1990 the money really started to pour in, hitting $8.5 million then $18 million in1991. Last years sales (1996) were $70 million and now this years' estimations are a substantial $160 million. There are currently 108 locations between Canada, the U.S., and Europe, with extreme success in London, England. Although the company could easily expand to may more locations, the company would prefer not to, at least no so fast. They believe that in order to maintain high levels of quality, staying in control, (which means going slowly) is the key. Frank Toskan, 45, founder and CEO of Make-up Art Cosmetics, was previously a Canadian hairstylist, make-up artist and photographer, who developed his own professional cosmetics because he felt that the existing lines couldn't link with the harsh lighting used in photography, stage , film and video work. Over the last 10 years, 160 shades of lipsticks in 7 different finishes, 150 eye shadows, 60 blushes and hair care have been created for the public. Toskan first started at his kitchen table with the help of his high school chemistry book. With Victor Casale, his chemist brother-in-law, he blended a few new colours. One year later, Toskan formed a partnership with Frank Angelo, a veteran entrepreneur (previous owner of a chain of beauty salons). At first they were turned down by banks, they had to mortgage everything in order to get the company going. M.A.C. was officially launched in 1985, in an old, run-down location in Toronto (Cabbagetown). For years M.A.C. was looked upon as too 'weird.' In1988, Toskan and Angelo had to beg downtown Simpsons -now the Hudson's Bay Company, to take their line of products. They were given a small corner and it soon became the most popular counter in the department store. Currently there are 23 M.A.C. Counters in Bay stores across Canada. Eaton's originally turned them away and now the partners won't deal with them. The company hires people based on creative talent, not looks; a novel tactic for this industry. Toskan is quoted saying: "I don't have the luxury of communicating with my clients, so therefore my salespeople are the link between my philosophy and their customers." M.A.C. reps behave more like friends or confidants than product pushers. Without having company sales pressure, the laid-back management resulted in a retail staff turnover of less than 7% last year. M.A.C. Cosmetics has a great position on corporate and social responsibility. The public image of this business is supported, due to many different surroundings. M.A.C. is "cruelty-free" and does not test its products on animals. They use simple black and white (recyclable) packaging and they encourage Recycling with the "Back-to-Mac" programme. Customers are given a free lipstick of their choice with the return of six empty containers. The company offers good prices compared to other 'big name' companies without any false promises such as miracle (age reducing) creams. While some companies may be nervous about linking their names to the specter of illness and death, M.A.C. is upfront in promoting its support of the fight against AIDS, with its popular lipstick -'Viva Glam,' 1992 (which also come with a condom) donated to various AIDS organizations. In Oct. 1995, M.A.C. launched a charity lipstick for $16: $6 of which, went to the breast cancer research. They also mix custom products to match the needs of cancer and burn victims on the allergenically challenged. Just recently M.A.C. introduced the "Kid's helping Kids" which, with the sale of greeting cards (painted by the kids) will be donated to pediatric organizations. M.A.C. Cosmetics has undertaken many strategies which resulted in the successfulness of the company. Toskan and Angelo had their business strategy figured out. At first they'd sell their make-up to professional stylists and artists and go on from there. Since make-up artists apply cosmetics to actresses and to models, this genius idea set a trend as it was featured in popular shows and/or movies and loved and utilized by favorite actresses. M.A.C. Cosmetics has never tried to target a certain group. Toskan planned to create every shade possible in order to offer a wide variety of shades for each individual. Without a single ad campaign, M.A.C. does not advertise because they do not believe that slogans are as explicit or as effective. They do not want to have to tell someone to buy their products. They also don't want to put a idealized corporate face on their product. They don't wan to make a women feel like she has to buy this product. Toskan brings a fresh new commitment to the business of beauty. "This industry has a history of digging into peoples pockets and taking advantage. I am interested in giving back to the consumer." M.A.C. Cosmetics also uses a word of mouth strategy (which apparently works). It only takes a few women to tell their friends how much they like a certain powder or certain lip gloss before they're all racing to the counters. "You don't really have to spend on advertising, yet your products on everybody's lips." Literally. Everyday, this company comes one step closer to its ultimate goal of providing the utmost value for its customers. M.A.C. works from an inverted pyramid - where the customers are always at the top. It is the customers who inspire Toskan and the company. This, along with the staff motivates him, not the money. "We didn't get into this business to make bags of money, or to have mass-consumer appeal, we just wanted to find the right colours." In the future they M.A.C. plan on opening locations in Hong Kong, the Far East, and more in Europe. Now in a joint venture with the U.S.'s largest privately owned cosmetics firm (Estee Lauder), M.A.C. will distribute products in overseas markets. With each and every goal M.A.C. is soon to be destined to hit the top. M.A.C. Cosmetics' reasons for all its plans are derived from the fact that it is the 90's. There are many serious issues and many different needs required today. Everyone is an individual, and this company sees that, and deliberately tries not to exclude anyone. Some trends are also created by the media exposure. The media has so much to do with what's in and what's out. But ultimately it is up to the consumer who decides. The products of Canada's Make-up Art Cosmetics, inspires devotion in many people, particularly the young and the glamorous. This is why a firm that started less than 15 years ago, created a product on a stove in a Toronto apartment had $70 million in sales last year. (1996) It has been the cause of more than a few envious looks by established cosmetic companies. The incredable entrepreneur behind this companies' success, often had a sense for smelling trends before the rest of the industry catches on. One of the remarkable aspects of the success of M.A.C. Cosmetics is the way the company has grown without the conversational help of big advertising campaigns, spokespersons or other big kinds of promotional gimmicks. This high quality company shows that advertising is not always needed. Being true to the customer and serving their needs brings success. This company is a leader and never follows what other companies do. Success can be found in many different ways, keeping in mind innovation and constant creation (of new ideas). M.A.C. is known to be an honest, caring and different company that strives to make the consumer happy and satisfied, while always remaining concerned with its social responsibility. f:\12000 essays\health & humanities (196)\MAD COW DISEASE.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Bovine Spongiform Encephalopathy Bovine spongiform encephalopathy (BSE) is a relatively new disease found primarily in cattle. This disease of the bovine breed was first seen in the United Kingdom in November 1986 by histopathological examination of affected brains (Kimberlin, 1993) . From the first discovery in 1986 to 1990 this disease developed into a large-scale epidemic in most of the United Kingdom, with very serious economic consequences (Moore, 1996). BSE primarily occurs in adult cattle of both male and female genders. The most common age at which cows may be affected is between the ages of four and five (Blowey, 1991). Due to the fact that BSE is a neurological disease, it is characterized by many distinct symptoms: changes in mental state 'mad-cow', abnormalities of posture, movement, and sensation (Hunter, 1993). The duration of the clinical disease varies with each case, but most commonly lasts for several weeks. BSE continues to progress and is usually considered fatal (Blowey, 1991). After extensive research, the pathology of BSE was finally determined. Microscopic lesions in the central nervous system that consist of a bilaterally symmetrical, non-inflammatory vacuolation of neuronal perikarya and grey-matter neuropil was the scientists' overall conclusion (Stadthalle, 1993). These lesions are consistent with the diseases of the more common scrapie family. Without further investigation, the conclusion was made that BSE was a new member of the scrapie family (Westgarth, 1994). Transmission of BSE is rather common throughout the cattle industry. After the incubation period of one to two years, experimental transmission was found possible by the injection of brain homogenates from clinical cases (Swanson, 1990). This only confirmed that BSE is caused by a scrapie-like infectious agent. How does the transmission become so readily available among the entire United Kingdom feedlot population? Studies showed that the mode of infection was meat and bone meal that had been incorporated into concentrated feedstuffs as a protein-rich supplement (Glausiusz, 1996). It is thought that the outbreak was started by a scrapie infection of cattle, but the subsequent course of the epidemic was driven by the recycling of infected cattle material within the cattle population (Lyall, 1996). Although the average rate of infection is very low, the reason why this led to such a large number of BSE cases is that much of the United Kingdom dairy cattle population was exposed for many, continuous years (Kimberlin, 1993). To help control the outbreak, the British government in 1988 introduced a ban on the feeding of ruminant protein to other ruminant animals (Lacey, 1995). Such knowledge for the pathogenesis of the BSE disease shows precisely the actions that must be taken in order to control and minimize the risk of infection in healthy cattle around the world (Darnton, 1996). The appearance of BSE has made a sizable impact throughout much of the world even though few countries, other than the United Kingdom, have experienced positive cases (Burton, 1996). The scare of an outbreak in other countries has led to a great disruption in the trade economy, as well as other factors concerning each of the country's general welfare. However, a rapid increase in the understanding of the disease over the last four years leaves few unanswered questions of major importance (Masood, 1996). BSE has been prevented, controlled and eradicated. As mentioned, BSE was first recognized in the United Kingdom and it is only there that a large-scale epidemic has occurred (Burton, 1996). By the end of 1990 well over 20,000 cases of BSE had been has been confirmed in England, Scotland, and Wales (Filders, 1990). The deadly epidemic started simultaneously in several parts of the country and cases have been distributed over a wide area ever since (Cowell, 1996). Besides the United Kingdom, cases of BSE have occurred in the Republic of Ireland. Some of these cases were associated with the importation of live animals, meat, and bone meal from the United Kingdom (Cherfas, 1990). Two cases of BSE have also occurred in cattle from the country of Oman. These animals were thought to be part of a consignment of fourteen pregnant heifers imported from England in 1985. Various cases have also been confirmed in Europe, Switzerland, and France (Patel, 1996). The economic consequences of BSE in the United Kingdom have been considerable. At the beginning, the only losses due to BSE were those directly associated with the death or slaughter of BSE infected animals (Cowell, 1996). In August 1988, a slaughter policy with part compensation was introduced to help lessen the burden on individual farmers. As the number of BSE cases increased , and more farmers were experiencing a second case, full compensation was introduced in February 1990 (Moore, 1996). In 1989 alone over 8,000 suspected and confirmed cases of BSE were slaughtered. The compensation costs for the year were well over 2.8 million pounds and the slaughter costs amounted to 1.6 million pounds (Cockburn, 1996). Once studies had identified meat and bone meal as the vehicle of infection, the United Kingdom Government banned the feeding of all ruminant-derived protein to ruminants (Glausiusz, 1996). This had an immediate impact on the cattle industry in terms of reduced exports and domestic sales of meat and bone meal (Hager, 1996). In 1990, the Commission of the European Communities banned the importation, from the United Kingdom, of all live cattle born before July 1988. Panic throughout the world caused many countries to entirely ban the importation of all live cattle from the United Kingdom. Some even went as far as to ban the importation of milk and milk products (Hunter, 1993). BSE has also had economic consequences in the human food industries. In the winter of 1989/1990, the United Kingdom Government banned the use for human food of certain specified bovine meats which contained suspicious amounts of BSE (Cockburn, 1996). This ban was introduced as a precautionary measure to help ensure the risks to public health from BSE were kept to a minimum. Most of the information concerning BSE has come from extensive studies of the scrapie agent. The agent is small enough to pass through bacteriological filters, thus demonstrating that it is virus-like or subviral in size (Kimberlin, 1993). Unfortunately, the agent has other properties which are atypical of viruses. The first contradiction is that infectivity is highly resistant to many physicochemical treatments, such as heat, and exposure to ionizing or ultra violet radiation (Swanson, 1990). Second, the disease does not induce an immune response from the host (Stadthalle, 1993). These two controversies along with the long incubation period explain why the scrapie group of agents have long been known as the "unconventional slow virus" (Westgarth, 1994). BSE is clearly not a disease of genetic origin. It has occurred in the majority of United Kingdom dairy breeds and their crosses, in the proportion expected from their representation in the national herd (Kimberlin, 1993). Analysis of available pedigrees excludes a simple Mendelian pattern of inheritance as the sole cause of the disease. Studies further showed that the occurrence of BSE was not associated with the importation of cattle, the use of semen, or the movement of breeding animals between herds (Hunter, 1993). By examining the epidemic curve, one can deduce that the disease is characteristic to that of an extended-source epidemic. By a simple process of elimination, the only common factor to be identified was the feeding of proprietary feedstuffs (Darnton, 1996). Commercial calf pellets, cow cakes, or protein supplements to home mixed rations have been fed to all cases where the infectious BSE disease is subsequently present. The balance of evidence shows that meat and bone meal is the primary vehicle of infection (Lacey, 1995). As previously explained, it is now assumed that scrapie was the original cause of the BSE epidemic. It is very likely that the epidemic was started by one scrapie strain that is common in different breeds of sheep, or possibly, a few strains that behave in a similar manner when crossing the sheep-to-cattle species barrier (Hunter, 1993). However, the continued exposure of cattle to sheep scrapie was not the ultimate driving force of the epidemic. On the contrary, the epidemic would inevitably have been amplified into a severe outbreak by the subsequent recycling, through meat and bone meal, of infected cattle material within the cattle population (Westgarth, 1994). Because of the length of BSE incubation periods, recycling would have already been established as the pattern for the epidemic long before BSE was even recognized (Cherfas, 1990). After a comprehensive study of nearly 200 cases of BSE, scientists were able to conclude that three significant clinical signs were present. Changes in mental state were observed, most commonly seen as apprehension, frenzy and nervousness when confronted by doorways and other entrances. Abnormalities of posture and movement occurred in 93 percent of the cases. The most common manifestations were hind-limb ataxia, tremors, and falling. Changes in sensation were a feature of 95 percent of all cases. The most striking evidence was continuous hyperaesthesia, to both touch and sound. These three most common clinical signs are consistent with a diffuse central nervous system disorder (Stadthalle, 1993). Other common signs were loss of body condition (78 percent), live weight loss (73 percent), and a reduced milk yield (70 percent). At some stage in the clinical course, about 79 percent of all cases showed one of the above general signs along with signs in each of the three neurological categories previously listed (Swanson, 1990). Unfortunately, the slaughter of the great majority of affected animals becomes necessary at an early stage because of unmanageable behavior and injury from repeated falling and uncontrollable behavior (Cowell, 1996). The duration of the clinical disease, from the earliest signs to death or slaughter, can range from under two weeks to as long as a year. The average period is about one to two months (Lyall, 1996). BSE resembles other members of the scrapie family in not having any gross pathological lesions associated with disease. Characteristic histo- pathological changes are found in the nervous system (Kimberlin, 1993). In common with the other diseases in the scrapie family, BSE has a distinctive non-inflammatory pathology with three main features. The most important diagnostic lesion is the presence of bilaterally symmetrical neuronal vacuolation, in processes and in soma. Hypertrophy of astrocytes often accompanies vacuolation. Cerebral amyloidosis is an inconstant histopathological feature of the scrapie family of diseases. At times, only one of the above will occur in an infected animal, while more often a combination of the three will occur (Swanson, 1990). Unfortunately, there are no routine laboratory diagnostic tests to identify infected cattle before the onset of clinical disease. The diagnosis of BSE therefore depends on the recognition of clinical signs and confirmation by histological examination of the central nervous system (Westgarth, 1994). A clinical diagnosis can also be confirmed by simple electron microscope observations, biochemical detection of SAF, or the constituent protein PrP (Hunter, 1996). At present, vaccination is not an appropriate way of preventing any of the diseases in the scrapie family. There is no known protective immune response to infection for a vaccine to enhance (Blowey, 1991). However, BSE is obviously not a highly contagious disease and it can be prevented by other simple means because the epidemiology is also relatively simple. Restrictions on trade in live cattle Restrictions on trade in meat and bone meal Sterilization of meat and bone meal Restricted use of meat and bone meal Minimizing exposure of the human population Minimizing the exposure of other species (Moore, 1996) A great deal of concern, much of it avoidable, has been expressed over the possible public health consequences of BSE. This is understanding given that the scrapie family of diseases include some that affect human beings (Patel, 1996). As a result of research, the circumstances in which BSE might pose a risk to public health can be defined quite precisely, and simple measures have been devised to prevent this risk (Kimberlin, 1993). It is important to emphasize that any primary human exposure would still be across a species barrier and there would be no recycling of food-born infection in the human population, as happened with kuru and with BSE in cattle (Patel, 1996). The logical way to address this risk is to make sure that exposure to BSE is kept to a bare minimum. There are two scenarios for the future course of BSE. The first is that BSE, like TME and kuru, is a dead-end disease. If this is true and meat and bone meal was the sole source of the infection, then removing this source would be sufficient for the eventual eradification of BSE from the United Kingdom (Hager, 1996). The alternative scenario is that there are natural routes of transmission of BSE and that the outbreak could turn into an endemic infection of cattle the way scrapie is in sheep (Burton, 1996). To sustain BSE infection in the cattle population requires that each breeding cow is replaced by at least one infected female calf, which then transmits infection to at least one of her offspring. For BSE to become an endemic, the number of infected cattle would need to increase by horizontal spread as seen in scrapie (Masood, 1996). The essential prerequisite for controlling such a deadly disease is through good breeding and movement records which are currently being compiled in the United Kingdom following recent legislation (Stadthalle, 1993). Meanwhile the precautionary measures to safeguard other species, including human beings, are already in place and refined to meet today's needs. f:\12000 essays\health & humanities (196)\Mandatory AIDS testing.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Mandatory AIDS Testing AIDS has become a worldwide epidemic that has struck every identifiable group. However, persons who are considered to be in a high-risk group of contracting HIV, the disease believed to cause AIDS, are still stigmatized by the media and other professionals as being diseased and abnormal. It is quite surprising still that this type of stereotype still exists now in our gender-bending society. No longer do only gays, prostitutes, bisexual men, intravenous drug users contract HIV, the heterosexual community is also facing the epidemic at phenomenon increases. It is estimated that heterosexual transmission accounts for 75% of all AIDS cases in the world.(Video, CBC In Review) And still individuals persist that AIDS is a gay disease and that if one is not gay, one is immune from it. No one is immune to from AIDS. Until a vaccine and cure is discovered for AIDS, the numbers will increase and people will keep dying. Therefore it is of vital importance to educate people about AIDS and to promote safer sex. The key word now is prevention. Among many proposed policies to help prevent AIDS infection, one of the most controversial is mandatory AIDS testing. Mandatory AIDS testing is theoretically very effective, however, when it is applied, it is not practical at all because one is dealing with human nature, the odd nature of the virus itself, and also all of the stigmas that are attached to AIDS. Therefore, not only will mandatory AIDS testing not prevent HIV infection, it will indirectly increase HIV infection because of the adverse effect it will have on voluntary testers. One of the major flaws of mandatory AIDS testing is that "it provides people with a false sense of security."(Greig, p68) When one goes for AIDS testing or more accurately an HIV antibody test which is also know as the ELISA test (Kolodny, p42), one tests for the presence of HIV antibodies not for the virus itself. Our bodies manufacture antibodies to fight against foreign infections, therefore the presence of HIV antibodies indicates that the person is infected with HIV and is considered a carrier and may infect others. However, if the person is infected recently enough, these antibodies might not show up in the test because it can take the body as long as six months to develop these antibodies. This period of time is known as the window period. So a person whose test returns with a negative HIV status may be in fact a carrier and not know it because the antibodies have not shown up yet. Misguided, this individual believing to be HIV negative, may participate in high risk activities for contracting HIV and infect others as well. Mandatory Aids testing also involves sub-policy known as contact tracing or partner notification. The intent of this policy is to have an individual who is HIV positive disclose his sexual history and all partners as well. Then the public health office will contact these partners and have them tested and educated. This policy fails to recognize that it is dealing with a very sensitive, and private issue and people might not want to disclose their sexual history. Also how will this information be verified? It will be of no surprise that certain individuals may lie and identify someone who they had no sexual contact with just to put that person through the hassle. Not only is this policy an infringement on privacy, it is not effective because there is no cure for AIDS. In the past, contact tracing was also implemented for other STD's(sexual transmitted diseases) such as syphilis, gonorrhea, herpes simplex where there is treatment for the diseases. (Greig, p71) For AIDS, there is no cure or vaccines, therefore, people living with AIDS(PWA) are not treated but in fact being re-educated again. With all the hassle and insecurity of the mandatory AIDS testing policy, people will become reluctant to test. Also because the results of the tests will be kept on file and the results are accessible by some selected individuals and groups, people will become even more hesitant to test voluntarily first let alone be mandatory. The consequences of public disclosure or even select disclosure are very damaging to a person who has just learned of his HIV positive status. Some of the negative consequences are alienation from community and family, loss of accommodation, denial of disability and life insurance, travel restrictions and also the prospect of "blackmailing". (IPC, HIV/AIDS, p17) The notion that mandatory AIDS testing and its implications deter people from voluntary testing is evident from the possible discrimination that one might face undergoing the procedures of the policy. As of today, there is no mandatory AIDS testing programs being implemented for persons of "high-risk groups". One cannot help but feel the society as a whole believes when one is dealing with an issue like AIDS, which is so sensitive and private, the rights and the comfort of the individuals stricken with this horrid disease should come first. As a result, anonymous testing has been made available to provide people with discretion and protection from discrimination. Although not many cities provide this sort of services, just the fact that it is available is a relief for those who suspect that they might be infected with HIV. This type of service encourages testing and is the right tool to help prevent HIV infection. Some of the question asked may be very difficult or even impossible to answer, but a strong debate can be put up for both sides. Can Aids testing control the spread of AIDS, for the individuals who seem to believe that it can, many argument go in it's favor. By promoting HIV testing "it enables those who have tested positive to seek early treatment. By learning of their infection, people with HIV can avoid unsafe practices that could infect others."(Bender, p.114) By doing this it will prevent those who are infected from spreading the virus to those who are not accidentally. A lot of the time when this virus is being passed it is done unknowingly. If this system were to be in place, it would be the end of people passing the virus off unknowingly. Leaving us with the few that have been found knowingly passing the disease. There have be some cases where a person who has been tested and knows that they have the virus, but continues to engage in an unsafe sexual manner. Therefore passing the virus off to other uninfected people. How should we deal with these individuals? Should there be a criminal punishment? How can we protect ourselves from these individuals? With this system it may crack down on this problem, and the a criminal punishment may follow. When testing not everyone must be tested only those who are in the high-risk groups, consisting of homosexuals, IV drug users and those who have partners that are infected with the HIV virus. This testing would inform people of possible HIV infection and enables them to seek early treatment. It also does a very important job in telling the person if he/she if a carrier of the virus. With this information hopefully the spread will drop in accidental cases this meaning a smaller number of AIDS cases. This isn't it only purpose it also helps the blood donor clinics such as the Red Cross in determining who has the virus and who doesn't. It would mean there would be a safer system in blood donating overall. It ensures the public that everyone who is giving blood is HIV/AIDS free. It is possible for one bad unit of blood to contaminate 10 000 - 30 000 other units of blood. That would be a huge catastrophe for the Red Cross. Lastly it gives individuals engaging in any sexual activities that added piece of mind that the person they are sleeping with does not have the AIDS virus. A case of a man who was infected with the HIV virus was found trying to donate blood at Red Cross located in Ottawa.(G&M, June 5/'95) Mr. Thornton in the fall of 1987 donated blood after being tested positive twice for HIV and not revealing that he was homosexual. A high risk group that the Red Cross won't except blood from. He had been warned not to donate blood, but did so any ways believing it would relieve his chances of developing AIDS if he got rid of some blood. One of his friend quoted him saying he wanted to see if he could set away with donating blood. Mr. Thornton thought his blood would be screened out. One has to remember the screening process isn't foolproof, in theory it would only catch 99.3 % of cases of infected blood. For this action, Mr. Thornton was found guilty in 1989 of committing a common nuisance endangering the lives or health of the public. He was sentenced to 15 months in jail. This has been the first case the top courts had to deal with involving the transmission of AIDS. Now a under existing laws, any one knowingly donating blood can be prosecuted. In another case this one being on the civil aspect involving a married father of two is suing the estate of his homosexual lover, saying the man failed to disclose that he was carrying the AIDS virus until shortly before dying.(Star, '94) This case is the first of its kind in Canada, and may end up setting the rights and duties of people in sexual relationships that involve AIDS. The man known as C.R. is seeking damages for negligence, negligent misrepresentation, assault and battery and breach of fiduciary obligation from the estate of a man known as J.T. He is suing for $250 000 in general damages and $ 75 000 in punitive and special damages. A good point made by the lawyer representing J.T. estate, " If you are going to have unprotected sex with a member of a high risk group you are partially negligent. This case shows that there are repercussion to ones actions you must be extremely selective of who you have sexual encounters with. It also looks more towards the civil side of AIDS and the law, the decision of the case was not obtained. It's safe to say that AIDS has changed our views on any sort of sexual activities we conduct ourselves in. Sexual conduct isn't the only thing we must worry about anymore because in a article in the Globe and Mail dating back to November, 11/'94. Those who donate blood must now face the fact that if they are HIV positive when donating, whether it be accidental or purposely the ruling was that the Red Cross would be able to give the names of the individuals to the public health office. "Donors implicated that having names released amounted to mandatory testing for acquired immune deficiency syndrome." (G&M, Nov.11/'94). In one last case in a recent newspaper ruled that some Red Cross workers could be charged with criminal negligence causing death if Justice Horace Krever's inquiry assigns them blame for their role in the tainted blood tragedy.(Sun., Nov '96) There are a dozen medical directors and senior managers that could be charged. Under these jurisdictions, committing a common nuisance and thereby endangering the lives, safety or health of the public. Criminal negligence in doing something or failing to perform a duty and showing wanton or reckless disregard for the lives or safety of others persons. Criminal negligence causing death and criminal negligence causing bodily harm to another person. The judge stated that the Red Cross failed to adequately fund its program in the 1980's; it didn't screen high-risk donors; it publicly understated the risk of blood borne AIDS virus and hepatitis C; it failed to buy safe, heat treated blood products as soon as they became available. Because of that several notices warning people he might cite them for misconduct. f:\12000 essays\health & humanities (196)\Medical Miracles on the Horizon.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Medical Miracles on the Horizon The world and its inhabitants will face a multitude of problems in the 21st Century, including drug addiction, deadly disease, violent crime, warfare and hostility, hunger, and homelessness to name a few. All of these critical issues have been present to some extent in the 20th Century and, left unsolved, will continue to plague society and mankind as we enter the new millennium. As we rapidly approach the next era, new issues of equal or even greater importance for mankind will almost certainly arise. I personally envision health issues, concerns related directly to medicine, as the central, most critical and comprehensive problem facing leaders of the 21st Century. In my opinion, physicians and others associated with the medical profession will participate in one of the most vital and urgent roles entering into the new era. This is one of the reasons that I intend to pursue a career in the medical field after I graduate from The University of Tennessee. Of all occupations in the next millennium, medicine will be perhaps the most important and influential in combating the problems of mankind and in solving them. People in the field of medicine will continue, as they have in this century, to address and participate in almost all concerns. For example, methadone is currently being used as a therapeutic intervention for some drug addictions. In addition, various medications are now being given in the treatment of criminals, like anti-psychotic drugs to curb aggressive or violent behavior in schizophrenics. A new and improved group of antidepressants is also being used to treat and reduce the growing rate of suicide in all ages of our society. Because a very high percentage of homeless people suffer from psychological problems and/or drug addictions, doctors may also eventually play a larger role in prescribing medication for these individuals. Concerning warfare that may be present into the 21st Century, the medical community will be required to detect and treat a variety of injuries and illnesses, just as they have had to decipher and work on patients who fell victim to the Gulf War Syndrome. Any future wars may have even more insidious side-effects due to the use of lethal chemicals. Cures have been found for many illnesses, such as polio, smallpox, and various childhood diseases in the present century, but other health concerns are manifesting rapidly. One of the most important task doctors and research scientists may face is to fight new strains of deadly diseases in the coming years. Outbreaks of eboli and the emergence of diseases that are drug-resistant to antibiotics threaten the survival of mankind. If humanity is to thrive and prosper in the 21st Century, each individual must do his or her own part to deal with the problems that are presently in existence as well as to prepare for the potential problems of the future. The path I will choose in solving some of the current and future considerations for mankind is the field of medicine. In other words, I want to be a part of the solution for the issues that face my own generation, as well as benefiting past and future generations. No one person can solve all of the dilemmas. It will take a concerted effort by a multitude of individuals in a variety of occupations and by concerned humanitarians who work for their own causes to improve living conditions and the quality of life in the next era. Doctors, scientists, teachers, social workers, politicians, leaders, and virtually every other segment of the population must team up in a joint effort to eradicate the serious issues facing our society in the 21st Century. For example, the leaders of the 21st Century must seek new methods and alternative plans to ensure the "well-being" of others as the Preamble of the United States Constitution declares as a basic "right." The leaders in our government need to go out into society, talk with people, study the pertinent concerns, and actively participate in finding solutions. They should ask questions such as: what should we do, how do we do it, and what is working for you? These leaders need to enlist the help of the medical community so that they may better realize and more fully understand that the hospitals and research centers need additional funds for new treatments, better facilities, and updated technology. In addition, a comprehensive health care program must be developed that is satisfactory to the citizens as well as to the health care professionals. In the field of medicine, we have much to look forward to as the new century begins. Great progress is currently being made in the medical field of genetics. In the 21st Century, it is very possible that many incurable diseases such as autism, diabetes, and others may be eliminated. Physicians and scientists are even showing some hope for a future cure for AIDS, a terrifying and rapidly spreading disease that is now in the top ten causes of death. Another field of medicine that will be extremely vital in the next era is that of geriatrics. As life expectancy continues to rise and our society continues to age, the field will undoubtably become one of the most exciting and critical of all. Many medical miracles are on the horizon because significant breakthroughs are pending, for the flu, for spinal cord injuries, for Parkinson's, and for many others. I truly believe that many diseases will be eradicated in the next millennium, and I look forward to being an active participant in finding the cures as well as treating the needy. I am still in the process of exploring, investigating, and evaluating the various options of the medical profession and have not yet decided which specialized path to follow. But I know that the profession of medicine is where I need to be, where I want to be, and where I will someday be. I am very focused, self-motivated, and determined in obtaining my goal to become a physician. Being a successful Medical Doctor means helping other people and solving complex problems in the next era, and this is what I will strive to do. I firmly believe that the world and its inhabitants will face a multitude of problems in the 21st Century, both old ones and new ones. In my opinion, the solution for most of these critical issues will be in some way related to the field of medicine, either through diagnosis, research, or treatment. Still, all segments of society must work together to make the new millennium prosperous and successful for all. My first step in being an active part of this concerted effort will be to earn my degree from the University of Tennessee so that I may one day reach my goal to be an active participant in the medical community and to fulfill my desire to help others. f:\12000 essays\health & humanities (196)\Minerals.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ MINERALS Minerals are required to build soft and hard body tissue. Without then we wouldn't exist. They also help out with the nervous system the contraction of mussels and help the blood flow properly. Minerals are classified into 2 major groups. The major elements such as calcium, magnesium, iron, iodine etc. Then the trace elements such as copper, manganese fluorine and zinc. Once of the most important is calcium. Calcium is used to build up your bones. It also helps to keep your teeth strong. About 90% of all calcium is stored in your bone's. It also helps with mussel contraction. Milk products such as milk, cheese and other stuff it the primary source for calcium. You should have about 1000mg's a day. Magnesium is also another important mineral. This mineral is in most foods. It is very important in containing healthy mussel cells. It also helps in forming bones. Sodium is another kind of mineral. Sodium is usually found in small but ok quantities in natural foods. If you have too much sodium it may cause edema. It may also give you high blood pressure. Iron is needed to form pigments in red blood cells. These cells transport the oxygen we need. men have more iron in there blood stream then women. You should have about 18 mg of iron each day. Zinc is required to keep your blood sugar level controlled. You also need to so you can taste and hear properly. It also helps to heal cuts. You should have about 15 mg per day of zinc. Boron is a mineral that helps keep strong bones. It affects calcium and magnesium. This also helps out so you have proper membrane functions. f:\12000 essays\health & humanities (196)\Multiple Sclerosis .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Jason Garoutte November 18, 1996 English / Mr. Blunt Multiple Sclerosis Multiple sclerosis is one of the most misunderstood diseases of this century. Since it's discovery, there is still no known causes, no proven treatments, and no known cure, yet it affects possibly five hundred thousand people in the United States alone. People need to learn more about this disease so it can be brought to the attention of the nation. Multiple Sclerosis is a disease of the central nervous system. It destroys the fatty myelin sheath that insulates your nerve cells. Without this insulation, nerve communication is disrupted. The body then makes this worse by repairing it, and clogging the area with scar tissue. Signals going from your brain and brain stem, such as muscle coordination signals or visual sensation signals, are slowed greatly, or just blocked off. Thus, a person afflicted with Multiple Sclerosis can suffer any number of symptoms. Researchers are not sure yet as to the cause of Multiple Sclerosis. There is a kind of deadlock among scientists and doctors whether it's hereditary, viral, or a combination of the two, with the disease being hereditary, but with a viral trigger, or just a simple chemical imbalance in the immune system. One thing is certain, though. Some sort of defect in the immune system causes white blood cells to attack and destroy the myelin sheath. There are five main types of Multiple Sclerosis. The first type is Benign Multiple Sclerosis. It is the least severe, has little progression, and takes up twenty percent of all cases. The second type is Benign Relapsing- Remitting Multiple Sclerosis. It carries symptoms that fluctuate in severity, mild disability, and it makes up thirty percent of the total. The third type is Chronic Relapsing Multiple Sclerosis. It is characterized by disability that increases with each attack, and it is the most common with forty percent of all cases. Chronic Progressive Multiple Sclerosis is the fourth type. It has continuous disability that worsens as time goes by, and ten percent of all cases are this. The last type is a very rare class called Acute Progressive Multiple Sclerosis. This kind can kill in weeks or months, in contrast with the usual years or decades. Due to the type of disease and the areas it affects, there are a great number of possible symptoms. These symptoms can fool the most experienced physician into thinking that it is a psychological disease. The most common symptoms are bouts of overwhelming fatigue, loss of coordination, muscle weakness, numbness, slurred speech, and visual difficulties. These symptoms may occur for a number of years before one is actually diagnosed, and these symptoms will appear with little or no warning. Attacks of these symptoms appear most often three to four years after the first incident. Multiple Sclerosis is diagnosed by a number of ways. Most of the time, the first test done is an MRI -- Magnetic Resonance Imaging Scanner. This test maps out your brain and looks for areas that have been scarred over, or 'plaques', and usually takes an hour. White spots on normally gray areas usually signify a plaque. Next, a lumbar puncture, more commonly known as a spinal tap, is done. This test involves some discomfort, and although the actual puncture lasts only fifteen minutes, the procedure can leave the patient disabled for anywhere from two hours to two weeks. About a week after the spinal tap is done, a series of three tests are performed to measure the time it takes for impulses to travel through your brain and nerves. These tests are known separately as the Visual Evoked Potential Test, the Auditory Evoked Potential Test, and the Electrodiagnostic Test. The Visual Evoked Potential Test, or V.E.P., records the brain wave patterns and reaction time with alternating patterns on a nearby monitor. The Auditory Evoked Potential Test, or A.E.P., uses pulses of sharp 'clicks' to time your reactions. In the final test, the electrodiagnostic, an electric current is passed through certain pressure points, and sensors on the head, chest, and back record just how fast the impulses are transmitting through your body and brain. With the positioning of the sensors, the technician can determine where a slowdown, if any, is occurring. The disease cannot be cured, and treatments are few. There is no common treatment that researchers can agree on. Some swear by diet treatments, which have been found by patients in nonclinical studies to slow or arrest the advancement of Multiple Sclerosis. Usually the diet therapies involve a few months eliminating allergic foods from your diet, and since foods that are slightly allergic are usually your favorite foods, it's a very hard treatment to stick to. Others swear by drugs and the like, such as ACTH (adrenocorticotropic hormone), which is the most commonly prescribed treatment, or copolymer I and cyclosporine, which have shown promise in laboratory studies. The statistics of Multiple Sclerosis are puzzling at best. For example, the fact that there are many more cases in the northern latitudes than in the southern latitudes is one thing that confuses researchers. As you approach the equator, patients suffering with Multiple Sclerosis are almost zero. Also, most victims are between the ages of twenty and forty-five years old, with the majority of them being women. Multiple Sclerosis also affects more people of the Caucasian persuasion. Multiple Sclerosis affects an estimated three hundred fifty to five hundred thousand Americans, with eight thousand more cases being reported each year. Fortunately, the average life span of a patient with Multiple Sclerosis is seventy-five percent of normal, and only a quarter of all diagnosed will ever need a wheelchair. Multiple Sclerosis is one of the most confusing diseases that has ever afflicted mankind. More and more possible treatments are found, but still no cure. So people with Multiple Sclerosis must learn to live with the disease, learn to cope. And others should learn more about the disease, so it isn't ignored in the future. f:\12000 essays\health & humanities (196)\Mumps.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ MUMPS Mumps is a disease caused by a virus and occurs only in human beings. Mumps is found all over the world. Mumps is a contagious disease when the salivary glands, on one or both sides of the jaw, swells. Mumps usually occurs in school age children, but young adults may catch the disease. Everyone born before1957 has already had mumps. After one attack of mumps, you will have lifelong immunity. The mumps virus is spread by contact of another person's discharge from the nose or mouth. The virus is present in these discharges from six days before symptoms to nine days after the glands begin to swell. The virus will then incubate for two to three weeks before symptoms appear. Symptoms include headaches, jaw being painful and tender to the touch, fever, and difficulty swallowing. The swelling usually disappears after seven to ten days. Some complications includedeafness (usually only in one ear), arthritis, meningitis (inflammation of brain membranes) and pancreatitis (inflammation of the pancreas). One of every four male adults with the virus will develop orchtis,which is inflammation of the testes. Sometimes females will have inflammation of the ovaries. Extremely rare cases will result in sterility. Mumps is diagnosed by symptoms, but a blood, urine or saliva test can confirm that you have the virus. Treatment of the virus includes diet of soft foods, bed rest, and pain relievers. The mumps vaccine is given to children that are about twelve months old. The vaccine is usually conbined with measles and rubella vaccines, which is called the MMR vaccine. f:\12000 essays\health & humanities (196)\Music in Stress Reduction.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ During the first week of my self change project I monitored my stress levels and the way music effected the mental and physical aspects of stress. From monitoring this properly, I found that listening to music pleasing to me at the specifically different times I experienced stress did help reduce my internal feelings and physical changes. In carefully studying the various types of stress experienced I concluded that certain types of music more effectively reduced my stress and anxiety levels. The following paragraphs explain further the types of stress felt and the music that assisted in subsiding the symptoms of stress. Stress can be felt in several different forms, included here are the following ways I experienced stress. This step was found to be particularly important in past studies to learn specific Œstress styles¹ and most importantly, what music reduced what symptoms of stress. There are six separate forms of stress that can be experienced. These are symptomatic in physical, behavioral, emotional, cognitive, spiritual, and relational aspects. Physical symptoms I personally experienced were: headaches (specifically tension headaches), nausea, dizziness, sleep difficulties, tight neck and shoulders, racing heart, trembling hands, and restlessness. Behavioral symptoms I felt were: a definite excess in smoking, bossiness towards others, compulsive gum chewing, I became critical of others, grinding of my teeth so hard that I am forced to wear a mouthpiece at night, and an inability to finish what I start. Some of the emotional symptoms included: crying, anxiety,nervousness, boredom, edginess, overwhelming sense of pressure, overwhelming anger, being unhappy for no reason, and very testy. Cognitive symptoms that I felt were: trouble thinking clearly, forgetfulness, writers block, long-term memory loss, inability to make decisions, and constant excessive worry. Spiritual aspects of stress that I felt: doubt, unforgiving, apathy, and a strong feeling for the need to prove myself. Examples of relational symptoms included: isolation, intolerance, resentment, clamming up, nagging/whining, distrust,and less contact with friends. The importance of identifying interpersonal feelings helps with deciding what music would be most effective in reducing stress. Here are my findings for different types of stress: For most physical symptoms, I found that a calming music worked best these CD¹s give a good example of calming, relaxing music (from my collection): Enya, The Vienna Boy¹s Choir, Collage (A compilation of classical works proven in a psychologically monitored project found to greatly reduce anxiety. They are collections that are popping up at several doctor office waiting areas to calm the patients.), Sarah McLachlan, and the Moscow Boy¹s Choir. For behavioral aspects of stress, I found that listening to music with a Œsing-a-long¹ interface worked best. I concluded that this was for the following reasons: A. it kept my mouth busy, and B. it kept my mind off the overhead of stress. Good examples of Œsing-a-long¹ songs are ones from soundtracks such as Grease, Footloose, even Disney soundtracks were fun and kept me singing. For part of the emotional symptoms I would listen to calming music and the other part I would listen to fast paced music that expressed how I felt at that particular time. For example, when felt like crying, I found it best to listen to depressing music because the act of crying actually is a form of expression that can build up as easily as anger and can help you feel a great sense of release when you do cry. For the anger/edginess aspect I found that listening to fast-paced music such as Nine Inch Nails and Hole helped me to get the anger or other emotion out. I did get confused when studying cognitive, spiritual, and relational Œstress styles¹, however, I found that relaxing music such as classical, incorporated with stress reducing techniques such as meditation greatly lowered my levels of stress. Throughout the duration of my self-change project I found that social support was virtually nilche. This was an independent study of my feelings and the actions I took my alleviate my feelings, not anyone else¹s. Stress styles and music for reducing the symptoms are extremely individual. I also found that there was no specific time of music listening required due to the simple fact that stress and emotions are so variable. Listening to a set time of specific music daily would frustrate me more that anything due to the fact that it would just be one more thing to add to my already stressful life and, again, because of the variation. A good comparison would be that of music to medicine. If you have an upset stomach, you take a medicine suitable to your symptoms, you wouldn¹t take an antihistamine, and so forth.... My current status in stress reduction is really very interesting due to finals. I have never felt so stressful in my life. I am mostly feeling anger and edginess at the time and at this vary moment, listening to music from the soundtrack Romeo and Juliet. Success of this project did not only include learning to control my stress levels, but I have found the topic interesting and am taking this into consideration for the future if I do become a psychiatrist. I applied extra research to this final report because I found it so interesting. This is certainly a skill I hope to carry into the future and i hope to share it with others as a personalized stress reducer, as stress is one of the most common illness inducers in today¹s society. I haven¹t found noticeable change in my overall behavior, but my attitude is definitely turning another direction. In fact, one of my peers told me that she admired how I so easily Œdisregarded¹ certain things that she could not. this was when I saw that it was really making a difference in my attitude. (this peer had no idea that I was working on this project) my motivation to finish school will always be the same. I know that I have to finish school to have a Œdecent¹ future, but when I do experience the feelings of ³it¹s just too hard² or ³I can¹t handle this much work² I can use music to motivate my spiritual symptoms and get myself up and going again. The whole theory of self-change taught me that almost anything is possible with a little motivation on my part. I feel that the skill of knowing how to change yourself is one that everyone should acquire. So many people are unhappy with things in their life that I feel that even the layman could understand that if she/he decided to change, she/he could. Future use of behavior change will most definitely come in handy. I already have a list of things I would like to change on my own time and knowing how and what to do will be more than enough motivation to get me going. My major goals in this specific self-change project would be the reduction of anxiety and stress through music therapy. Hopefully this will follow me into the rest of my life, including stress in family life and in my chosen career. Secondary goals that I have acquired through study on the topic are actually using music therapy in my future career. To be specific, I would like to turn and use music along with psychodynamic therapy to help heal pediatric oncology patients. At this time in my college career, I feel that I am fulfilling my goals, but certainly not to their best. Hopefully, through this and other self-change projects, I can prepare myself for today and the future. Self-change is, I found, something that can only continue in your life if you use it . If you do follow through, eventually, the change will become a part of you and not a simple Œbehavior you don¹t like¹. f:\12000 essays\health & humanities (196)\Narcissicm.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ On Narcissism: Psychological Theories and Therapeutic Interventions in the Narcissistic Disorders Introduction Understanding the Narcissistic Phenomenon The so called 'narcissistic personality disorder' is a complex and often misunderstood disorder. The cardinal feature of the narcissistic personality is the grandiose sense of self importance, but paradoxically underneath this grandiosity the narcissist suffers from a chronically fragile low self esteem. The grandiosity of the narcissist, however, is often so pervasive that we tend to dehumanize him or her. The narcissist conjures in us images of the mythological character Narcissus who could only love himself, rebuffing anyone who attempted to touch him. Nevertheless, it is the underlying sense of inferiority which is the real problem of the narcissist, the grandiosity is just a facade used to cover the deep feelings of inadequacy. The Makeup of the Narcissistic Personality The narcissist's grandiose behavior is designed to reaffirm his or her sense of adequacy. Since the narcissist is incapable of asserting his or her own sense of adequacy, the narcissist seeks to be admired by others. However, the narcissist's extremely fragile sense of self worth does not allow him or her to risk any criticism. Therefore, meaningful emotional interactions with others are avoided. By simultaneously seeking the admiration of others and keeping them at a distance the narcissist is usually able to maintain the illusion of grandiosity no matter how people respond. Thus, when people praise the narcissist his or her grandiosity will increase, but when criticized the grandiosity will usually remain unaffected because the narcissist will devalue the criticizing person. Akhtar (1989) [as cited in Carson & Butcher, 1992; P. 271] discusses six areas of pathological functioning which characterize the narcissist. In particular, four of these narcissistic character traits best illustrate the pattern discussed above. " (1) a narcissistic individual has a basic sense of inferiority, which underlies a preoccupation with fantasies of outstanding achievement; (2) a narcissistic individual is unable to trust and rely on others and thus develops numerous, shallow relationships to extract tributes from others; (3) a narcissistic individual has a shifting morality-always ready to shift values to gain favor; and (4) a narcissistic person is unable to remain in love, showing an impaired capacity for a committed relationship". The Therapeutic Essence of Treating Narcissism The narcissist who enters therapy does not think that there is something wrong with him or her. Typically, the narcissist seeks therapy because he or she is unable to maintain the grandiosity which protects him or her from the feelings of despair. The narcissist views his or her situation arising not as a result of a personal maladjustment; rather it is some factor in the environment which is beyond the narcissist's control which has caused his or her present situation. Therefore, the narcissist expects the therapist not to 'cure' him or her from a problem which he or she does not perceive to exist, rather the narcissist expects the therapist to restore the protective feeling of grandiosity. It is therefore essential for the therapist to be alert to the narcissists attempts to steer therapy towards healing the injured grandiose part, rather than exploring the underlying feelings of inferiority and despair. Differential Psychological Views of Narcissism The use of the term narcissism in relation to psychological phenomena was first made by Ellis in 1898. Ellis described a special state of auto-erotism as Narcissus like, in which the sexual feelings become absorbed in self admiration (Goldberg, 1980). The term was later incorporated into Freud's psychoanalytic theory in 1914 in his essay 'On Narcissism'. Freud conceptualized narcissism as a as a sexual perversion involving a pathological sexual love to one's own body (Sandler & Person, 1991). Henceforth, several psychological theories have attempted to explain and treat the narcissistic phenomenon. Specifically, the most comprehensive psychological theories have been advanced by the psychodynamic perspective and to a lesser extent the Jungian (analytical) perspective. Essentially, both theories cite developmental problems in childhood as leading to the development of the narcissistic disorder. The existential school has also attempted to deal with the narcissistic problem, although the available literature is much smaller. Existentialists postulate that society as a whole can be the crucial factor in the development of narcissism. The final perspective to be discussed is the humanistic approach which although lacking a specific theory on narcissism, can nevertheless be applied to the narcissistic disorder. In many ways the humanistic approach to narcissism echoes the sentiments of the psychodynamic approach. The Psychodynamic Perspective of Narcissism The psychodynamic model of narcissism is dominated by two overlapping schools of thought, the self psychology school and the object relations school. The self psychology school, represented by Kohut, posits that narcissism is a component of everyone's psyche. We are all born as narcissists and gradually our infantile narcissism matures into a healthy adult narcissism. A narcissistic disorder results when this process is somehow disrupted. By contrast the object relations school, represented by Kernberg, argues that narcissism does not result from the arrest of the normal maturation of infantile narcissism, rather a narcissism represents a fixation in one of the developmental periods of childhood. Specifically, the narcissist is fixated at a developmental stage in which the differentiation between the self and others is blurred. Kohut's Theory of Narcissism Kohut believes that narcissism is a normal developmental milestone, and the healthy person learns to transform his or her infantile narcissism into adult narcissism. This transformation takes place through the process which Kohut terms transmuting internalizations. As the infant is transformed into an adult he or she will invariably encounter various challenges resulting in some frustration. If this frustration exceeds the coping abilities of the person only slightly the person experiences optimal frustration. Optimal frustration leads the person to develop a strong internal structure (i.e., a strong sense of the self) which is used to compensate for the lack of external structure (i.e., support from others). In the narcissist the process of transmuting internalizations is arrested because the person experiences a level of frustration which exceeds optimal frustration. The narcissist thus remains stuck at the infantile level, displaying many of the characteristics of the omnipotent and invulnerable child (Kohut, 1977). Kernberg's Theory of Narcissism Kernberg's views on narcissism are based on Mahler's theory of the separation- individuation process in infancy and early childhood. Mahler's model discusses how the developing child gains a stable self concept by successfully mastering the two forerunner phases (normal autism and normal symbiosis) and the four subphases (differentiation, practicing, rapprochement, and consolidation) of separation-individuation. Kernberg argues that the narcissist is unable to successfully master the rapprochement subphase and is thus fixated at this level. It is essential, however, to understand the dynamics of the practicing subphase before proceeding to tackle the narcissist's fixation at the rapprochement subphase. The practicing subphase (age 10 to 14 months) marks the developmental stage at which the child learns to walk. The ability to walk gives the child a whole new perspective of the world around him. This new ability endows the child with a sense of grandiosity and omnipotence which closely resemble the narcissist's behavior. However, reality soon catches up with the child as the child enters the rapprochement subphase (age 14 to 24 months). At this stage the child discovers that he or she is not omnipotent, that there are limits to what he or she can do. According to Kernberg if the child is severely frustrated at this stage he or she can adapt by re-fusing or returning to the practicing subphase, which affords him the security of grandiosity and omnipotence (Kernberg, 1976). The Preferred Psychodynamic model The Psychodynamic literature in general tends to lean towards the object relations school because of the emphasis it places on a comprehensive developmental explanation (i.e. the use of Mahler's individuation-separation model). Nevertheless, the theory of Kohut has left a deep impression on Psychodynamic thinking as is evident by the utilization of many of his concepts in the literature (i.e. Johnson, 1987; Manfield, 1992; and Masterson, 1981). Therefore in the remainder of the Psychodynamic section a similar approach will be taken, by emphasizing object relations concepts with the utilization of the occasional Kohutian idea. The Emergence of the Narcissistic Personality According to Kernberg and the object relations school the crisis of the rapprochement subphase is critical to the development of the narcissistic personality. The individual who is unable to successfully master the challenges of this stage will sustain a narcissistic injury. In essence the narcissistic injury will occur whenever the environment (in particular significant others) needs the individual to be something which he or she is not. The narcissistically injured individual is thus told "Don't be who you are, be who I need you to be. Who you are disappoints me, threatens me angers me, overstimulates me. Be what I want and I will love you" (Johnson, 1987; P. 39). The narcissistic injury devastates the individual's emerging self. Unable to be what he or she truly is the narcissistically injured person adapts by splitting his personality into what Kohut terms the nuclear (real) self and the false self. The real self becomes fragmented and repressed, whereas the false self takes over the individual. The narcissist thus learns to reject himself or herself by hiding what has been rejected by others. Subsequently, the narcissist will attempt to compensate for his or her 'deficiencies' by trying to impress others through his or her grandiosity. The narcissist essentially decides that "There is something wrong with me as I am. Therefore, I must be special" (Johnson, 1987; P. 53). The Narcissist's View of Others Just as the individual becomes narcissistic because that is what the environment 'needed' him or her to be, so does the narcissist view others not as they are, but as what he or she needs them to be. Others are thus perceived to exist only in relation to the narcissist's needs. The term object relations thus takes on a special meaning with the narcissist. "We are objects to him, and to the extent that we are narcissistic, others are objects to us. He doesn't really see and hear and feel who we are and, to the extent that we are narcissistic, we do not really see and hear and feel the true presence of others. They, we, are objects... I am not real. You are not real. You are an object to me. I am an object to you" (Johnson, 1987; P. 48). It is apparent than that the narcissist maintains the infantile illusion of being merged to the object. At a psychological level he or she experiences difficulties in differentiating the self from others. It is the extent of this inability to distinguish personal boundaries which determines the severity of the narcissistic disorder (Johnson, 1987). Levels of Narcissism The most extreme form of narcissism involves the perception that no separation exists between the self and the object. The object is viewed as an extension of the self, in the sense that the narcissist considers others to be a merged part of him or her. Usually, the objects which the narcissist chooses to merge with represent that aspect of the narcissist's personality about which feelings of inferiority are perceived. For instance if a narcissist feels unattractive he or she will seek to merge with someone who is perceived by the narcissist to be attractive. At a slightly higher level exists the narcissist who acknowledges the separateness of the object, however, the narcissist views the object as similar to himself or herself in the sense that they share a similar psychological makeup. In effect the narcissist perceives the object as 'just like me'. The most evolved narcissistic personality perceives the object to be both separate and psychologically different, but is unable to appreciate the object as a unique and separate person. The object is thus perceived as useful only to the extent of its ability to aggrandize the false self (Manfield, 1992). Types of narcissism Pending the perceived needs of the environment a narcissist can develop in one of two directions. The individual whose environment supports his or her grandiosity, and demands that he or she be more than possible will develop to be an exhibitionistic narcissist. Such an individual is told 'you are superior to others', but at the same time his or her personal feelings are ignored. Thus, to restore his or her feelings of adequacy the growing individual will attempt to coerce the environment into supporting his or her grandiose claims of superiority and perfection. On the other hand, if the environment feels threatened by the individual's grandiosity it will attempt to suppress the individual from expressing this grandiosity. Such an individual learns to keep the grandiosity hidden from others, and will develop to be a closet narcissist. The closet narcissist will thus only reveal his or her feelings of grandiosity when he or she is convinced that such revelations will be safe (Manfield, 1992) Narcissistic Defense Mechanisms Narcissistic defenses are present to some degree in all people, but are especially pervasive in narcissists. These defenses are used to protect the narcissist from experiencing the feelings of the narcissistic injury. The most pervasive defense mechanism is the grandiose defense. Its function is to restore the narcissist's inflated perception of himself or herself. Typically the defense is utilized when someone punctures the narcissist's grandiosity by saying something which interferes with the narcissist's inflated view of himself or herself. The narcissist will then experience a narcissistic injury similar to that experienced in childhood and will respond by expanding his or her grandiosity, thus restoring his or her wounded self concept. Devaluation is another common defense which is used in similar situations. When injured or disappointed the narcissist can respond by devaluing the 'offending' person. Devaluation thus restores the wounded ego by providing the narcissist with a feeling of superiority over the offender. There are two other defense mechanisms which the narcissist uses. The self-sufficiency defense is used to keep the narcissist emotionally isolated from others. By keeping himself or herself emotionally isolated the narcissist's grandiosity can continue to exist unchallenged. Finally, the manic defense is utilized when feelings of worthlessness begin to surface. To avoid experiencing these feelings the narcissist will attempt to occupy himself or herself with various activities, so that he or she has no time left to feel the feelings (Manfield, 1992). Psychodynamic Treatment of the Narcissist The central theme in the Psychodynamic treatment of the narcissist revolves around the transference relationship which emerges during treatment. In order for the transference relationship to develop the therapist must be emphatic in understanding the patient's narcissistic needs. By echoing the narcissist the therapist remains 'silent' and 'invisible' to the narcissist. In essence the therapist becomes a mirror to the narcissist to the extent that the narcissist derives narcissistic pleasure from confronting his or her 'alter ego'. Grunberger's views are particularly helpful in clarifying this idea. According to him "The patient should enjoy complete narcissistic freedom in the sense that he should always be the only active party. The analyst has no real existence of his own in relation to the analysand. He doesn't have to be either good or bad-he doesn't even have to be... Analysis is thus not a dialogue at all; at best it is a monologue for two voices, one speaking and the other echoing, repeating, clarifying, interpreting correctly-a faithful and untarnished mirror" (Grunberger, 1979; P. 49). The Mirror Transference Once the therapeutic relationship is established two transference like phenomena, the mirror transference and the idealizing transference, collectively known as selfobject transference emerge. The mirror transference will occur when the therapist provides a strong sense of validation to the narcissist. Recall that the narcissistically injured child failed to receive validation for what he or she was. The child thus concluded that there is something wrong with his or her feelings, resulting in a severe damage to the child's self- esteem. By reflecting back to the narcissist his or her accomplishments and grandeur the narcissist's self esteem and internal cohesion are maintained (Manfield, 1992). There are three types of the mirror transference phenomenon, each corresponding to a different level of narcissism (as discussed previously). The merger transference will occur in those narcissists who are unable to distinguish between the object and the self. Such narcissists will perceive the therapist to be a virtual extension of themselves. The narcissist will expect the therapist to be perfectly resonant to him or her, as if the therapist is an actual part of him or her. If the therapist should even slightly vary from the narcissist's needs or opinions, the narcissist will experience a painful breach in the cohesive selfobject function provided by the therapist. Such patients will then likely feel betrayed by the therapist and will respond by withdrawing themselves from the therapist (Manfield, 1992). In the second type of mirror transference, the twinship or alter-ego transference, the narcissist perceives the therapist to be psychologically similar to himself or herself. Conceptually the narcissist perceives the therapist and himself or herself to be twins, separate but alike. In the twinship transference for the selfobject cohesion to be maintained, it is necessary for the narcissist to view the therapist as 'just like me' (Manfield, 1992). The third type of mirror transference is again termed the mirror transference. In this instance the narcissist is only interested in the therapist to the extent that the therapist can reflect his or her grandiosity. In this transference relationship the function of the therapist is to bolster the narcissist's insecure self (Manfield, 1992). The Idealizing Transference The second selfobject transference, the idealizing transference, involves the borrowing of strength from the object (the therapist) to maintain an internal sense of cohesion. By idealizing the therapist to whom the narcissist feels connected, the narcissist by association also uplifts himself or herself. It is helpful to conceptualize the 'idealizing' narcissist as an infant who draws strength from the omnipotence of the caregiver. Thus, in the idealizing transference the therapist symbolizes omnipotence and this in turn makes the narcissist feel secure. The idealization of the object can become so important to the narcissist that in many cases he or she will choose to fault himself or herself, rather than blame the therapist (Manfield, 1992). The idealizing transference is a more mature form of transference than the mirror transference because idealization requires a certain amount of internal structure (i.e., separateness from the therapist). Oftentimes, the narcissist will first develop a mirror transference, and only when his or her internal structure is sufficiently strong will the idealizing transference develop (Manfield, 1992). Utilizing the Transference Relationship in Therapy The selfobject transference relationships provide a stabilizing effect for the narcissist. The supportive therapist thus allows the narcissist to heal his or her current low self esteem and reinstate the damaged grandiosity. However, healing the current narcissistic injury does not address the underlying initial injury and in particular the issue of the false self. To address these issues the therapist must skillfully take advantage of the situations when the narcissist becomes uncharacteristically emotional; that is when the narcissist feels injured. It thus becomes crucial that within the context of the transference relationship, the therapist shift the narcissist's focus towards his or her inner feelings (Manfield, 1992). The prevailing opinion amongst Psychodynamic theorists is that the best way to address the narcissist's present experience, is to utilize a hands-off type of approach. This can be accomplished by letting the narcissist 'take control' of the sessions, processing the narcissist's injuries as they inevitably occur during the course of treatment. When a mirror transference develops injuries will occur when the therapist improperly understands and/or reflects the narcissist's experiences. Similarly, when an idealizing transference is formed injuries will take the form of some disappointment with the therapist which then interferes with the narcissist's idealization of the therapist. In either case, the narcissist is trying to cover up the injury so that the therapist will not notice it. It remains up to the therapist to recognize the particular defense mechanisms that the narcissist will use to defend against the pain of the injury, and work backwards from there to discover the cause of the injury (Manfield, 1992). Once the cause of the injury is discovered the therapist must carefully explore the issue with the narcissist, such that the patient does not feel threatened. The following case provides a good example of the patience and skill that the therapist must possess in dealing with a narcissistic patient. "...a female patient in her mid-thirties came into a session feeling elated about having gotten a new job. All she could talk about is how perfect this job was; there was no hint of introspection or of any dysphoric affect. The therapist could find no opening and made no intervention the entire session except to acknowledge the patient's obvious excitement about her new job. Then, as the patient was leaving, the therapist noticed that she had left her eyeglasses on the table. He said, "you forgot your glasses," to which she responded with an expression of surprise and embarrassment saying, "Oh, how clumsy of me." This response presented the therapist with a slight seem in the grandiose armor and offered the opportunity for him to intervene. He commented, "You are so excited about the things that are happening to you that this is all you have been able to think about; in the process you seem to have forgotten a part of yourself." The patient smiled with a mixture of amusement and recognition. In this example the patient is defending throughout the session and in a moment of surprise she is embarrassed and labels herself "clumsy", giving the therapist the opportunity to interpret the defense (her focus on the excitement of the external world) and how it takes her away from herself" (Manfield, 1992; PP. 168-169). The cure of the narcissist than does not come from the selfobject transference relationships per se. Rather, the selfobject transference function of the therapist is curative only to the extent that it provides an external source of support which enables the narcissist to maintain his or her internal cohesion. For the narcissist to be cured, it is necessary for him or her to create their own structure (the true self). The healing process is thus lengthy, and occurs in small increments whenever the structure supplied by the therapist is inadvertently interrupted. In this context it is useful to recall Kohut's concept of optimal frustration. "If the interruptions to the therapist's selfobject function are not so severe as to overwhelm the patient's deficient internal structure, they function as optimal frustrations, and lead to the patient's development of his own internal structure to make up for the interrupted selfobject function" (Manfield, 1992; P. 167). The Jungian (Analytical) Perspective of Narcissism Analytical psychology views narcissism as a disorder of Self-estrangement, which arises out of inadequate maternal care. However, prior to tackling narcissism it is useful to grasp the essence of analytical thought. The Ego and the Self in Analytical Psychology It is important to understand that the Self in analytical psychology takes on a different meaning than in psychodynamic thought (Self is thus capitalized in analytical writings to distinguish it from the psychodynamic concept of the self). In psychodynamic theory the self is always ego oriented, that is the self is taken to be a content of the ego. By contrast, in analytical psychology the Self is the totality of the psyche, it is the archetype of wholeness and the regulating center of personality. Moreover, the Self is also the image of God in the psyche, and as such it is experienced as a transpersonal power which transcends the ego. The Self therefore exists before the ego, and the ego subsequently emerges from the Self (Monte, 1991). Within the Self we perceive our collective unconscious, which is made up of primordial images, that have been common to all members of the human race from the beginning of life. These primordial images are termed archetypes, and play a significant role in the shaping of the ego. Therefore, "When the ego looks into the mirror of the Self, what it sees is always 'unrealistic' because it sees its archetypal image which can never be fit into the ego" (Schwartz-Salant, 1982; P. 19). Narcissism as an Expression of Self-Estrangement In the case of the narcissist, it is the shattering of the archetypal image of the mother which leads to the narcissistic manifestation. The primordial image of the mother symbolizes paradise, to the extent that the environment of the child is perfectly designed to meet his or her needs. No mother, however, can realistically fulfill the child's archetypal expectations. Nevertheless, so long as the mother reasonably fulfills the child's needs he or she will develop 'normally'. It is only when the mother fails to be a 'good enough mother', that the narcissistic condition will occur (Asper, 1993). When the mother-child relationship is damaged the child's ego does not develop in an optimal way. Rather than form a secure 'ego-Self axis' bond, the child's ego experiences estrangement from the Self. This Self-estrangement negatively affects the child's ego, and thus the narcissist is said to have a 'negativized ego'. The negativized ego than proceeds to compensate for the Self-estrangement by suppressing the personal needs which are inherent in the Self; thus "the negativized ego of the narcissistically disturbed person is characterized by strong defense mechanisms and ego rigidity. A person with this disturbance has distanced himself from the painful emotions of negative experiences and has become egoistic, egocentric, and narcissistic" (Asper, 1993; P. 82). Analytical Treatment of Narcissism Since the narcissistic condition is a manifestation of Self-estrangement, the analytical therapist attempts to heal the rupture in the ego-Self axis bond, which was created by the lack of good enough mothering. To heal this rupture the therapist must convey to the narcissist through emphatic means that others do care about him or her; that is the therapist must repair the archetype of the good mother through a maternally caring approach (Asper, 1993). A maternal approach involves being attentive to the narcissist's needs. Just as a mother can intuitively sense her baby's needs so must the therapist feel and observe what is not verbally e f:\12000 essays\health & humanities (196)\Near & Farsightedness.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ What are visual defects and how common are they ? by Nate Schackow 2nd Period December 17, 1996 The human eye does alot more than allowing you to see. It is very complex and has many parts and features which can have defects. However, to understand defects you must first know how the eye works. First light passes through the cornea, which is the transparent part of the sclera, or white of the eye, which is composed of tough fiberous tissue. Behind the sclera is a watery fluid called the aqueous humor. This fluid fills a cresent-shaped space which with the cornea helps bend the light toward the center of the eye. Under the aqueous humor is the iris which gives the eye color. The color of the iris has no effect on how you see and is inherited through genes. The iris contols how much light is allowed to enter your by opening up further when it is dark and closing up more to block out some light when it is bright. Everything that passes through the pupil, which looks like a black dot, is what you see. Next the light passes through the lens. The lens focuses the light rays onto the retina forming an image in reverse and upside-down. Finally light-sensitive cells in the retina transmit the image via the optic nerve to the brain by electrical signals. Then the brain flips the image so it looks right-side-up to you. You can find a diagram of the above on page 3. page 1 The most common visual defects are nearsightedness and farsightedness. In nearsightedness, also known as myopia, the eye is longer than usual. This is corrected by using a concave lens to spread the light rays just enough to increase the eye's focal length. Hyperopia, also known as farsightedness, is caused by a shorter than usual eye. A convex lens increases light bending and returns the point of focus to the retina. page 2 Bibliography Coon, Dennis, Introduction to Psychology, St. Paul, Minnesota, West Publishing Company, 1989, pp. 85-87. "Eye," Compton's Interactive Encyclopedia, 1994, 1995 Compton's NewMedia, Inc. Pierenne, M. H., Vision and the Eye, London, England, Chapman and Hall Ltd., 1967, pp. 2-9. page 4 What are visual defects and how common are they ? by Nate Schackow 2nd Period December 17, 1996 The human eye does alot more than allowing you to see. It is very complex and has many parts and features which can have defects. However, to understand defects you must first know how the eye works. First light passes through the cornea, which is the transparent part of the sclera, or white of the eye, which is composed of tough fiberous tissue. Behind the sclera is a watery fluid called the aqueous humor. This fluid fills a cresent-shaped space which with the cornea helps bend the light toward the center of the eye. Under the aqueous humor is the iris which gives the eye color. The color of the iris has no effect on how you see and is inherited through genes. The iris contols how much light is allowed to enter your by opening up further when it is dark and closing up more to block out some light when it is bright. Everything that passes through the pupil, which looks like a black dot, is what you see. Next the light passes through the lens. The lens focuses the light rays onto the retina forming an image in reverse and upside-down. Finally light-sensitive cells in the retina transmit the image via the optic nerve to the brain by electrical signals. Then the brain flips the image so it looks right-side-up to you. You can find a diagram of the above on page 3. page 1 The most common visual defects are nearsightedness and farsightedness. In nearsightedness, also known as myopia, the eye is longer than usual. This is corrected by using a concave lens to spread the light rays just enough to increase the eye's focal length. Hyperopia, also known as farsightedness, is caused by a shorter than usual eye. A convex lens increases light bending and returns the point of focus to the retina. page 2 Bibliography Coon, Dennis, Introduction to Psychology, St. Paul, Minnesota, West Publishing Company, 1989, pp. 85-87. "Eye," Compton's Interactive Encyclopedia, 1994, 1995 Compton's NewMedia, Inc. Pierenne, M. H., Vision and the Eye, London, England, Chapman and Hall Ltd., 1967, pp. 2-9. page 4 What are visual defects and how common are they ? by Nate Schackow 2nd Period December 17, 1996 The human eye does alot more than allowing you to see. It is very complex and has many parts and features which can have defects. However, to understand defects you must first know how the eye works. First light passes through the cornea, which is the transparent part of the sclera, or white of the eye, which is composed of tough fiberous tissue. Behind the sclera is a watery fluid called the aqueous humor. This fluid fills a cresent-shaped space which with the cornea helps bend the light toward the center of the eye. Under the aqueous humor is the iris which gives the eye color. The color of the iris has no effect on how you see and is inherited through genes. The iris contols how much light is allowed to enter your by opening up further when it is dark and closing up more to block out some light when it is bright. Everything that passes through the pupil, which looks like a black dot, is what you see. Next the light passes through the lens. The lens focuses the light rays onto the retina forming an image in reverse and upside-down. Finally light-sensitive cells in the retina transmit the image via the optic nerve to the brain by electrical signals. Then the brain flips the image so it looks right-side-up to you. You can find a diagram of the above on page 3. page 1 The most common visual defects are nearsightedness and farsightedness. In nearsightedness, also known as myopia, the eye is longer than usual. This is corrected by using a concave lens to spread the light rays just enough to increase the eye's focal length. Hyperopia, also known as farsightedness, is caused by a shorter than usual eye. A convex lens increases light bending and returns the point of focus to the retina. page 2 Bibliography Coon, Dennis, Introduction to Psychology, St. Paul, Minnesota, West Publishing Company, 1989, pp. 85-87. "Eye," Compton's Interactive Encyclopedia, 1994, 1995 Compton's NewMedia, Inc. Pierenne, M. H., Vision and the Eye, London, England, Chapman and Hall Ltd., 1967, pp. 2-9. page 4 What are visual defects and how common are they ? by Nate Schackow 2nd Period December 17, 1996 The human eye does alot more than allowing you to see. It is very complex and has many parts and features which can have defects. However, to understand defects you must first know how the eye works. First light passes through the cornea, which is the transparent part of the sclera, or white of the eye, which is composed of tough fiberous tissue. Behind the sclera is a watery fluid called the aqueous humor. This fluid fills a cresent-shaped space which with the cornea helps bend the light toward the center of the eye. Under the aqueous humor is the iris which gives the eye color. The color of the iris has no effect on how you see and is inherited through genes. The iris contols how much light is allowed to enter your by opening up further when it is dark and closing up more to block out some light when it is bright. Everything that passes through the pupil, which looks like a black dot, is what you see. Next the light passes through the lens. The lens focuses the light rays onto the retina forming an image in reverse and upside-down. Finally light-sensitive cells in the retina transmit the image via the optic nerve to the brain by electrical signals. Then the brain flips the image so it looks right-side-up to you. You can find a diagram of the above on page 3. page 1 The most common visual defects are nearsightedness and farsightedness. In nearsightedness, also known as myopia, the eye is longer than usual. This is corrected by using a concave lens to spread the light rays just enough to increase the eye's focal length. Hyperopia, also known as farsightedness, is caused by a shorter than usual eye. A convex lens increases light bending and returns the point of focus to the retina. page 2 Bibliography Coon, Dennis, Introduction to Psychology, St. Paul, Minnesota, West Publishing Company, 1989, pp. 85-87. "Eye," Compton's Interactive Encyclopedia, 1994, 1995 Compton's NewMedia, Inc. Pierenne, M. H., Vision and the Eye, London, England, Chapman and Hall Ltd., 1967, pp. 2-9. page 4 What are visual defects and how common are they ? by Nate Schackow 2nd Period December 17, 1996 The human eye does alot more than allowing you to see. It is very complex and has many parts and features which can have defects. However, to understand defects you must first know how the eye works. First light passes through the cornea, which is the transparent part of the sclera, or white of the eye, which is composed of tough fiberous tissue. Behind the sclera is a watery fluid called the aqueous humor. This fluid fills a cresent-shaped space which with the cornea helps bend the light toward the center of the eye. Under the aqueous humor is the iris which gives the eye color. The color of the iris has no effect on how you see and is inherited through genes. The iris contols how much light is allowed to enter your by opening up further when it is dark and closing up more to block out some light when it is bright. Everything that passes through the pupil, which looks like a black dot, is what you see. Next the light passes through the lens. The lens focuses the light rays onto the retina forming an image in reverse and upside-down. Finally light-sensitive cells in the retina transmit the image via the optic nerve to the brain by electrical signals. Then the brain flips the image so it looks right-side-up to you. You can find a diagram of the above on page 3. page 1 The most common visual defects are nearsightedness and farsightedness. In nearsightedness, also known as myopia, the eye is longer than usual. This is corrected by using a concave lens to spread the light rays just enough to increase the eye's focal length. Hyperopia, also known as farsightedness, is caused by a shorter than usual eye. A convex lens increases light bending and returns the point of focus to the retina. page 2 Bibliography Coon, Dennis, Introduction to Psychology, St. Paul, Minnesota, West Publishing Company, 1989, pp. 85-87. "Eye," Compton's Interactive Encyclopedia, 1994, 1995 Compton's NewMedia, Inc. Pierenne, M. H., Vision and the Eye, London, England, Chapman and Hall Ltd., 1967, pp. 2-9. page 4 What are visual defects and how common are they ? by Nate Schackow 2nd Period December 17, 1996 The human eye does alot more than allowing you to see. It is very complex and has many parts and features which can have defects. However, to understand defects you must first know how the eye works. First light passes through the cornea, which is the transparent part of the sclera, or white of the eye, which is composed of tough fiberous tissue. Behind the sclera is a watery fluid called the aqueous humor. This fluid fills a cresent-shaped space which with the cornea helps bend the light toward the center of the eye. Under the aqueous humor is the iris which gives the eye color. The color of the iris has no effect on how you see and is inherited through genes. The iris contols how much light is allowed to enter your by opening up further when it is dark and closing up more to block out some light when it is bright. Everything that passes through the pupil, which looks like a black dot, is what you see. Next the light passes through the lens. The lens focuses the light rays onto the retina forming an image in reverse and upside-down. Finally light-sensitive cells in the retina transmit the image via the optic nerve to the brain by electrical signals. Then the brain flips the image so it looks right-side-up to you. You can find a diagram of the above on page 3. page 1 The most common visual defects are nearsightedness and farsightedness. In nearsightedness, also known as myopia, the eye is longer than usual. This is corrected by using a concave lens to spread the light rays just enough to increase the eye's focal length. Hyperopia, also known as farsightedness, is caused by a shorter than usual eye. A convex lens increases light bending and returns the point of focus to the retina. page 2 Bibliography Coon, Dennis, Introduction to Psychology, St. Paul, Minnesota, West Publishing Company, 1989, pp. 85-87. "Eye," Compton's Interactive Encyclopedia, 1994, 1995 Compton's NewMedia, Inc. Pierenne, M. H., Vision and the Eye, London, England, Chapman and Hall Ltd., 1967, pp. 2-9. page 4 f:\12000 essays\health & humanities (196)\Nutrition and You.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Nutrition and You Nutrition is the relationship of foods to the health of the human body . Proper nutrition means that you are receiving enough foods and supplements for the body to function at optimal capacity. It is important to remember that no single nutrient or activity can maintain optimal health and well being, although it has been proven that some nutrients are more important than others. All of the nutrients are necessary in different amounts along with exercise to maintain proper health. There are six main types of nutrients used to maintain body health. They are: carbohydrates, fats, proteins, vitamins, minerals, and water . They all must be in balance for the body to function properly. There are also five major food groups. The groups are: fats and oils, fruits and vegetables, dairy products, grains, and meats. Exercise is also an important part of nutrition. Exercise helps tone and maintain muscle tissue and ensure that the body's organs stay in good condition. Healthy eating without exercise will not result in good nutrition and a healthy body - neither will exercise without nutrition. The most important thing about exercise is that it be practiced regularly and that it be practiced in accompaniment with a healthy diet. It is also desirable to practice more that one sport as different sports exercise different areas of the body. Carbohydrates, proteins, and fats are the sources of energy for the body. The contained energy is expressed in calories. There are 9 calories per gram in fat and there are about 4 calories per gram in proteins and carbohydrates . Carbohydrates are the main source of energy for the body. This energy is mostly used for muscle movement and digestion of food. Some sources of carbohydrates are : grains, fruits, vegetables, and anything else that grows out of the ground. The energy in carbohydrates is almost instantly digested. This results in a quick rise in blood sugar which is soon followed by a drop in blood sugar which is interpreted by the body as a craving for more sugars. This sugar low may also result in fatigue, dizziness, nervousness, and headache. However, not all carbohydrates do this. Most fruits, vegetables, legumes, and whole grains are digested more slowly. Fats, which are lipids, are the source of energy that is the most concentrated. Fats produce more that twice the amount of energy that is in carbohydrates or proteins. Besides having a high concentration of energy, fat acts as a carrier for the fat soluble vitamins, A, D, E, and K. Also, by helping in the absorption of vitamin D, fats help make calcium available to various body tissues, in particular, the bones and teeth. Another function of fat is to convert carotene to vitamin A. Fat also helps keep organs in place by surrounding them in a layer of fat. Fat also surrounds the body in a layer that preserves body temperature and keeps us warm. One other function of fat is to slow the production of hydrochloric acid thereby slowing down digestion and making food last longer. Some sources of fats are meats and nuts as well as just plain oils and fats. Proteins, besides water, are the most plentiful substance in the body. Protein is also one of the most important element for the health of the body. Protein is the major source of building material in the body and is important in the development and growth of all body tissues. Protein is also needed for the formation of all hormones. It also helps regulate the body's water balance. When proteins are digested they are broken down into simpler sections called amino acids. However, not all proteins will contain all the necessary amino acids. Most meat and dairy products contain all necessary amino acids in their proteins. Proteins are available from both plants and animals. However, Animal proteins are more complete and thus desirable. Knowledge of the nutrients and their function is essential to understanding the importance of good nutrition. As mentioned above, there are six nutrients. All vitamins are organic food substances that are found only in living things, plants and animals . It is believed that there are about twenty substances that are active as vitamins in human nutrition . Every vitamin is essential to the proper growth and development of the body. With a few exceptions, the body cannot make vitamins and must be supplied with them. Vitamins contain no energy but are important as enzymes which help speed up nearly all metabolic functions. Also, vitamins are not building components of body tissues, but aid in the construction of these tissues. It is impossible to reliably determine the vitamin requirements of an individual because of differences in age, sex, body size, genetic makeup, and activity. A good source of a recommendation is the RDA. The RDA makes it's recommendations based on studies of consumption of the given nutrient. On the recommendation it will usually specify what size diet the recommendation is based on, for example, a two thousand calorie per day diet. It is harmless to ingest excess of most vitamins. However, some vitamins are toxic in large amounts. Vitamin A is a fat soluble vitamin which is only available in two forms. Pre-formed, which is found in animal tissue. The other is carotene, which can be converted into Vitamin A by animals . Carotene is found in easily found in carrots as well as other vegetables . Vitamin A is important to the growth and repair of body tissues and helps maintain a smooth, soft, and disease free skin. It also helps protect the mucus membranes of the mouth, nose, throat, and lungs which reduces the chance of infection. Another function is helping mucus membranes combat the effects of air pollutants. Vitamin A also protects the soft lining of all the digestive tract. Another function of vitamin A is to aid in the secretion of gastric juices. The B complex vitamins have many known sub-types, but they all are water soluble vitamins. The B vitamins can be cultivated from a variety of bacteria, yeast, fungi, or molds . They are active in the body by helping the body convert carbohydrates into glucose, a form of sugar. B vitamins are also vital in the metabolism of proteins and fats. They are also the single most important element in the health of the nerves. B vitamins are also essential for the maintenance of the gastrointestinal tract, the health of the skin, hair, eyes, mouth, liver, and muscle tone. The intestine contain a bacteria that produces vitamin b but milk-free diets, and taking sulfonamides or antibiotics can destroy these bacteria . Whole grains contain high concentrations of B complex vitamins. Also, enriched bread and cereal products contain high concentrations of B vitamins due to a governmental intervention of the whole food group to ensure that the nation was getting enough B vitamins Vitamin C, also known as ascorbic acid, is a water soluble vitamin. It is sensitive to oxygen and is the least stable of all vitamins . One primary function of vitamin C is to maintain collagen, a protein necessary for the formation of skin, ligaments, and bones. Vitamin C also plays a role in healing of burns and wounds because it aids the formation of scar tissue. It also helps form red blood cells and prevent hemorrhaging. Another function is to prevent the disease, scurvy, which used to be seen in sailors because of their lack of vitamin C in their diet. This was corrected by issuing each sailor one lime per day which supplied citric acid, a source of vitamin C. Other sources include broccoli, Brussels sprouts, Strawberries, Oranges, and grapefruits . Vitamin E is a fat soluble vitamin which is made up of a group of compounds called tocoherols. There are seven forms of it but the form known as Alpha tocoherol is the most potent . Tocoherols occur in the highest concentrations in cold pressed vegetable oils, all whole raw seeds and nuts, and soybeans. Vitamin E plays an essential role in cellular respiration of all muscles, especially the cardiac and skeletal. It makes these muscles able to function with less oxygen, thereby increasing efficiency and stamina. It also is an antioxidant, which prevents oxidization. This prevents saturated fatty compounds from breaking down and combining to form toxic compounds. Minerals are nutrients that exist in the body and in organic and inorganic combinations . There are approximately seventeen minerals that are necessary in human nutrition . Although only about four or five percent of the body weight is mineral matter, minerals are important to overall mental and physical health. All of the body's tissues and fluids contain some amount of mineral. Minerals are necessary for proper muscle function and many other biological reactions in the body. Minerals are also important in the production of hormones. Another important function of minerals is to maintain the delicate water balance of the body and to regulate the blood's pH. Physical and emotional stress causes a strain on the body's supply of minerals. A mineral deficiency often results in illness, which may be treated by the addition of the missing mineral to the diet. Calcium, a primary mineral, is available through dairy products. In order to get all the other minerals, one should eat protein rich foods, seeds, grains, nuts, greens, and limited amounts of salt or salty foods. Nutrition is just one aspect of total body health. It is important to remember that on must compliment good nutrition with good exercise and emotional health in order to achieve complete well being. It is also important to remember that no one part of nutrition will completely fulfill the body's requirements for health. f:\12000 essays\health & humanities (196)\Nutrition in mountian biking.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ BIBLIOGRAPHY Alsberg, Tony Langley, Jim "Tickets to Nowhere" Bicycling Febuary 1997 pgs 68-69 Walsh, Julie "Eating for the Long Haul" Bicycling September 1996 pgs 74-76 Walsh, Julie "Liquid Assets" Bicycling March 1996 pgs 98-99 Walsh, Julie "Super Bowls" Bicycling Febuary 1996 pgs 82-83 Walsh, Julie "Waterworld" Bicycling August 1996 pgs 92-96 OUTLINE I. Waterworld 1. Muscles produce 30-100 times more heat while riding 2. Water doesn't supply calories, minerals, or vitamins A. But it is used for almost every body function B. 55-65% of body weight is water 3. When losing a quart of fluid heart beats 8 more times a minute 4. Before a long ride start hyperhydrating 1 day in advance 5. Do drinking strategies during your training II. Rehydrate 1. Drink alot after a ride 2. Sports drinks replenish the best 3. Eat alot of salty snacks A. Sodium makes your blood like a sponge B. meals contain more sodium naturally than sports bars III. Diet helps 1. 60% of your daily fluid comes from food 2. Fruit and vegatables are great fluid sources 3. Foods high in fat do not provide to much fluid IV. Equipment 1. Warm up bikes are good for bad weather or the dark 2. Good for intense intervals V. Liquids 1. Replenish your self after rides 2. As soon as the rides over is the best time to replenish 3. Drink or eat 100 grams of carbo 4. Drinking carbo is much faster than eating carbo 5. You can spend over $1000 a year on recovery drinks VI. Cereal 1. Flakes are carbo rich, low in fat, and quickly digested 2. Sugar coated are not bad either 3. Most cereals contain less than 2 grams of fat per serving Nutrition in Mountain Biking When riding a bicycle, your muscles produce 30-100 times more heat than when your body is at rest. The body puts out this inferno by increasing the sweat rates. In the summer you can lose over two liters of fluid per hour on a really hot day, dehydration and saddle soars are the leading reasons cyclists drop out of races. The body loses this much fluid mostly from an increase in sweat rates. Water does not supply calories, minerals, or vitamins, but it is mandatory almost for every body function. It keeps body temperatures from rising while the person is exercising. Water accounts for 55-65% of your body weight. Cyclist that lose over a quart rate, which goes up to eight beats per minute a decrease in cardiac function, and an increase in body temperature. This is a study by Edward Coyle Ph.D. Director of the Humane Performance Laboratory at the University of Texas (Walsh 92). Dehydration can possibly increase metabolic stress on muscles. It also causes problems on your internal thermostat by decreasing blood flow to the skin, slowing sweat rates, and increasing the time needed for fluids to be absorbed into the blood stream. What is worse, by the time you feel thirsty, your body has already lost 1-2% of its body weight. Drink lots of water every day, but before a long ride or a race, start hyper hydrating twenty four hours in advance. Avoid drinks containing alcohol or caffeine because they both make the body excrete more water. If you can not meet your calorie needs, use sports drinks, recovery drinks or other liquid supplements. Try to step fluid lost to sweat, practice drinking strategies during your training. Determine how much sweat you lose by weighing yourself before and after your rides Every pound lost equals sixteen ounces of fluids. It takes practice to drink more than a quart of fluid per hour without getting cramps or internal discomfort. A hydration bladder system such as Camelbak, provides water and will help you drink more (Walsh 94). After you have ridden for a while drink plenty of fluids. What you drink after the ride can make a difference. Coyle also compared the effects of drinking nearly two liters of water, sport drinks, or diet cola in athletes two hours after a workout, the results showed diet cola replenishes 54% of the fluids lost; water, 64%; and sport drinks, 69%. Before or while riding you should eat salty snacks. Sodium makes your blood like a sponge so you can absorb more water and excrete less. Athletes such as cyclists should also drink plentiful with meals and snacks, because food naturally contains many times more sodium than soft drinks or energy bars (Walsh 95). About 60% of your daily fluid comes from the food you eat, but some foods increase hydration better than others. Fruits and vegetables are great fluids sources, they are 80-95% water by weight. Fat and Water do not mix very well, so many foods high in fat do not provide plenty of water (Walsh 95). Most popular sport drinks contain sodium, potassium, and other electrolytes. Sport drinks are useful for short high intensity workouts, such as sprints or intervals cool fluids taste better and may be absorbed more rapidly than warm drinks (Walsh 95). Watch the start of any race and you will see an odd sight: Racers furiously spinning in place, warming up on bikes attached to trainers. These devices are also great for workouts when the weather is bad or it is dark. If you enjoy intense intervals, you can knock yourself out since there is no distractions (Langley, Alsberg 68). If you just finish a big ride you should put down a sugary drink and start thinking about your next ride. You should already be preparing for your next ride by replenishing yourself of the things you lost on your previous ride. Eating plenty of pasta can also replenish a great deal of carbohydrates you burned, but not as much as soft drinks or water. During a ride, carbohydrates in your muscles and your liver is burned to produce energy so you can keep on going. As soon as the ride is over, the enzymes and receptors responsible for storing carbohydrates in the muscle and liver tissues are most active, this is the best time to replenish yourself (Walsh 98). The common recommendation after a big ride is to drink or eat 100 gram of carbohydrates. One hundred grams of carbohydrates is equal to four bananas, or four, eight ounce glasses of fruit juice. If you do plenty of short intervals, then drink or eat 100 grams of carbohydrates every two to four hours afterward (Walsh 98). Drinking energy makes more sense than eating; it is easier to slurp from a bottle than it is to put down a plate of pasta. There is also evidence showing that liquids are faster at moving energy from your stomach to your muscles. When riding the best drink for refueling is probably a sport drink like Gatorade of Powerade. Trained cyclists have found out that people who drank a beverage containing carbohydrates and protein replenishes muscle carbohydrates levels 38% quicker tan those who drank carbohydrates only. When carbohydrates is combined with protein, glycogen storage is enhanced post exercise. Nutritionists recommend cyclists consume 1.2-1.5 grams of protein per kilogram of body weight. (For a 150 pound cyclists, that 80-100 grams of protein daily.) The downside of these recovery drinks is they are expensive. You can spend up to $1,000 or more a year buying sports drinks (Walsh 99). A bowl of flakes is convenient, carbohydrates rich, low in fat, quickly digested and provides plenty of nutrients for the dollar. The nutritional profile of many cereals is similar to sports bars and recovery drinks. A bowl of raisin bran with a cup of skim milk provides 330 calories. About 80% of these are energy packed carbohydrates calories. Sugar coated or frosted cereals aren't intrinsically bad, they are better than eating nothing, but they do tend to lack nutrients. Nutrition labels separate carbohydrate content into sugars, dietary fibers, and other carbohydrates. Cyclists who have sugar rushes should avoid cereals that have sugar listed as one of the three ingredients (Walsh 82). Even the fattest flakes are skinny compared to sausage or French toast. Most cereals contain less than 2 grams of fat per serving. Pudgy cereals would be those with more than three grams of fat per serving these generally include granola, and flaked cereal with nuts (Walsh 82). The competitive sport of mountain biking is making its way to the United States. The sport which was mainly held in Europe, has come to the United States and beginning to draw a heap of notable foreign competitors. According to most estimates, cycling is the most popular spectator sport in the world, just behind soccer. The mountain bike is having improvements made to everyday, and people are willing to spend the money to get the best bike (Comptons Interactive Encyclopedia). f:\12000 essays\health & humanities (196)\Obesity.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ America has become a society obsessed with appearance, especially weight. We are conditioned at a young age to believe the only way to be normal is to be thin. This norm is projected to millions of Americans each day through television, magazines, billboards and every other form of media and advertising. How are people to know acceptance and happiness with themselves and others when our culture propagates what the perfect body should be. It is the search for the elusive, perfect body that has created a thirty-three billion dollars a year weight loss industry. Yet few reduce their body fat and even fewer maintain their weight loss beyond two to three years. This leads to yo-yo dieting and increased low self-esteem of people constantly struggling to become what they see as a normal member of society. A problem that lies within this problem, is the chronically obese person. Obesity is when one's body wieght is 25-30% above normal. While overweight is 20-30 pounds over normal. Most people, including health care providers see the problem with obesity as eating too much and exercising too little. But in truth, for many obese people the problem lies with genetic predisposition, metabolic problems, binge eating or sometimes all. These factors make dieting virtually impossible because these problems are not ones that can be solved by simply cutting calories. Especially the problem of binge eating. Compulsive "binge" eating in the obese is not caused by just wanting to eat. The want to eat is caused by looking for a sense of security. A sense of security wanted because there are poor or no coping skills for stress or depression and low self-esteem. Therefore, when a compulsive overeater or binge eater diet, the diet is doomed to fail because the weight returns when the person resumes normal eating. Thus creating an even greater depression. Now many obese people have medical research to turn to as to why the weight they lost usually comes back. Recent research has strongly backed the set-point theory, which says that when an individual loses weight, the body's metabolic rate adjusts in order to return to the baseline weight. Research with animals has revealed a protein called leptin. Leptin circulates in the blood and signals the set point mechanism in the brain, which tells how much fat is present in the body. The protein is believed to be produced by an obesity gene called ob. When leptin is injected into rodents, it lessened appetite and increased calories being burned. However, leptin is still very much in early experimental stages, because even though it may gauge how much fat you have it does not at this point tell how much you want. Another recent breakthrough was the discovery of unocortin. Unocortin appears to suppress appetite when the body is under severe stress. It is a cousin of the brain chemical that generates the body's "fight or flight" response. Unocortin was discovered at the Salk Institute, when a researcher was studying a neuropeptide which activates body stress reactors. He noticed receptors in parts of the brain where the chemical did not exist. However, it may be a long time before unocortin is actually a consumer drug. At this time, the only way unocortin works is to be directly injected into the brain. A company called Neurocin Biosciences, is already researching the brain receptor unocortin locks onto to work. For now, the serotonin reuptake inhibitor drugs are the only diet drugs being used in the U.S. These drugs work by affecting eating behavior. Eating behavior is the result of a mixture of neurotransmitters. The link between serotonin and eating disorders was discovered in the early 1980's. The serotonin inhibitors include Lovan, Redux and phen-fen (Phentermine and Fenfluramine). Phen-fen is the drug combination currently recieving so much attention. Phentermine is similar to an amphetamine and it works to increase metabolic rate. Fenfluramine(brand name Pondimin) in- creases the serotonin level, which decreases appetite. However, neither drug works alone. They only have optimum effect together. Phen-fen is how I became interested in the research of new obesity drugs. I first learned of phen-fen in June. The article I read in the Knoxville paper about people who had taken the medicine, showed it to be what I and many others had been waiting for. I finally believed my real chance to lose weight had arrived. So with real anticipation, I made the two and half hour drive to Monticello, Kentucky. My first month on the medicine was great, I lost fourteen pounds and completely lost any desire to eat. The compulsion I normally felt late at night to snack was gone. My problem with phen-fen began the second month, when I started experiencing depression. One of the possible side effects mentioned was depression in people who had suffered clinical depression or were prone to depression. I knew this when I started the medicine, but I thought anything was worth risking if it meant losing weight. By the third month, the depression was worse and I had to make a decision. Was it really worth losing weight if it meant losing my mental stability? I decided it was not worth it to me. When I made the decision, I could not believe the choice I made. My whole life has been spent wishing I had a different body. I thought that losing weight was somehow going to solve every problem I had. But when I realized I did not want to be depressed again, I realized that thin people have problems to and my problems would exist no matter what the size tag in my clothes read. After I quit taking the medicine, the urge to eat whether I was hungry or not did return. But I have continued to fight the urges and so far have only gained a couple of pounds back from what I lost. Perhaps the thing I most of the medicine, was the energy and the feeling of motivation. Other side effects of phen-fen are dry mouth, dizziness, short-term memory loss, and in some the serious problem of pulmonary hypertension. The New England Journal of Medicine presented an editorial on the benefits and risk of phen-fen and other drugs in this class. The physicians who wrote the article, wrote that considering the health risks of obesity for some, that the possible risk for pulmonary hypertension did not outweigh the benefits of the drugs if used appropriately. Overall, I am glad I took the risk to try phen-fen. There was always the posibility that the med- icine might have worked for me. But I am also glad that I have an understanding of the body's metabolic nature and was able to recognize my symptoms for depression. For many others, the lack of understanding of what is going on in their body is why many who have tried phen-fen have not been successful with their experience. Therefore, it is the physician's responsibility to completely inform clients of all possible side effects and to thoroughly explain to them what is going on in their body while they are taking the medication. It is also anyone's responsibility who is serious about taking any medication of this sort, to find out for themselves what is going on and what could happen. In this paper I have outlined various physical causes of obesity and possible treatments for the physical factors. But medication, exercise, healthy diet, none of these things will effectively cause permanent weight loss until a person is ready to be happy with their body and their overall self. You cannot successfully lose weight if you think your life is suddenly going to get better after the weight is gone. You have to want to do it because you love yourself and you want a healthier body. I think this is the most important thing I have finally learned about life and about myself. I hope that in the future there will be a time when people are not judged by their appearance, therefore those that think a different body will make them happy, will finally be able to be believe their worth is based on who they are and not what they look like. f:\12000 essays\health & humanities (196)\Observation of Early Childhood.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Observation of the Early Childhood An observation was held in the children"s wing of Tarrant County Junior College. A variety of children between the ages of two to six were observed in activities ranging from physical and motor to social and cognitive development. Specifically I mean that whether it was leadership skills or lack of, running, climbing and jumping, drawing and writing, or anything that could fall between, it has been seen, done and accounted for in the following observation. First let's start with the physical and motor development. Please say hello to Karligh and Bethany, my first volunteers of the observation. Both girls are in the four-year olds. The first activities under physical and motor development that I'm going to observe them performing are the large muscle/gross-motor skills. The large muscle/gross-motor skills include: climbing across the monkey bars, riding bigwheels (or tricycles), and running through a built-in obstacle course on the playground. Starting with the monkey bars, it's clearly obvious that Karligh is physically stronger upperbody-wise than Bethany. With surprising ease, Karligh crossed the monkey bars using nothing but her arms to perform this task. Bethany on the otherhand was shaky and uncertain from the start. After hanging from the first bar, she quickly swung her feet over to the side for leg support. She was able to cross but only with a great deal of assistance from me. Karligh also showed mastery in riding the big wheel. Her speed and turning ability seemed to surpass anyone else on the playground. Bethany chose to ride only after a piece of candy bribery. Her tricycle skills were somewhat sluggish but more or less average. However, once again Bethany was victorious. The last large muscle activity was completing the obstacle course. The obstacle course involved running up a slide, crawling through a tunnel, crossing a shaky bridge and then walking along a balance beam. Karligh ran up the slide with a considerable amount of effort. She quickly crawled through the tunnel and crossed the shaky bridge with little effort. She crossed the balance beam more quickly than I'd seen any child do that whole day. Bethany climbed up the slide in a time that was a bit quicker than Karligh's. The crawling through the tunnel was done quickly and she was first stalled on the shaky bridge. She managed to cross the bridge in a modest time but she hit some trouble at the balance beam. After slowly completing about ten percent of the travel across the beam, she turned her feet sideways for the remainder of the crossing, which took about two minutes. The second area in the physical and motor development involves the use of small muscle or fine motor skills. For the observation, these skills include writing, and playing the drums (the only two fine motor skills I saw both children perform). These children are four years old so when I say writing I of course am not talking about paragraphs or even sentences. More simply, my writing section only involved writing their names. Karligh was able to produce her name on paper in a legibility that was impressive for someone four years of age. Bethany too was able to write her name but just not quite as nice as Bethany. After observing the two children playing the drums, I think it's unlikely for either girl to win a scholarship for college as a percussionist. Bethany's playing was sporadic and entirely inconsistent but hey, she's only four. Karligh's drumming skills were a bit more impressive since she managed to lay down and keep a beat for a short amount of time. In judging overall competence in gross and fine-motor skills, it's obvious Karligh was better at both, but for most children competence seemed to lean more on one than the other. The "strong kids" on the playground who were the fastest tricycle riders, the highest jumping and so on, seemed to shy away from more of the finer fine motor skills. As for the kids that seemed significantly dominate in fine-motor skills, they were more likely to be seen playing in the sand box or just taking it easy as opposed to climbing, jumping, etc. This didn't always hold as true. As mentioned before, there were exceptions such as Karligh. Now we're on to the second half of the observation, which involves social and cognitive development. This section includes sociodramatic play, drawing pictures, counting and identifying leadership skills or the lack of. The first half of this section takes place in the kindergarten's room where all of the kids are five or six years of age. The sociodramatic play I saw involved two kids (Matt and Tyler), three wooden box-like objects and a board that was close to the size of a board seen on a seesaw. The three wooden boxes are spaced about eight inches apart, side by side, with the board lying across all three boxes. The board hangs past the boxes approximately three feet. So what do you have???? That's right, a spaceship. No specific movies or TV shows are mentioned in this play. We simply have Matt as the pilot and Tyler as the copilot as the two fly over the galaxy fighting other spaceships. Now the children are landing the spaceship at an airport where Matt says he's going to work on it. The children hop off the ship and shift the board and climb back on the ship to "go fight some other guys." In the middle of a battle Miss Williams, the teacher, announces that it's cleanup time and she pops the clean up song in the tape player. Without hesitation and in fact enthusiastically, Matt and Tyler hop of their spaceship, as it once again becomes three wooden boxes and a long board, and proceed to put the objects away as they sing the "clean up song." The second part of the social and cognitive development section is where I observed a child drawing a picture. William is the five year old artist I observed. William is making a noble effort trying to draw an airplane. Probably the most interesting part of William's drawing is the human characteristics he gives to the airplane. The airplane is standing upright with its tail, which looks much like a person's legs planted firmly on the ground. The wings go straight out, side to side and carry the resemblance of a person's arms. The head of the plane has an overall accurate shape to that of a real airplane. On the head of the plane, William has drawn in two eyes and a smiling mouth. The only thing left out(reasonably speaking that is when taking into consideration that a five year old child is drawing this) is a fully developed tail. William was unwilling to give up his picture for my project. The counting section was short and sweet. Once again the observation is back in the four year olds age group. Karligh, Madison, Lincoln and Zann were the four participants in the counting contest. The rules are simple, count till you can't count no more. Our first dropout of the contest was the physical and motor development queen, that's right, Karligh. Karligh couldn't go past twelve. Madison hung on until twentythree and Zann lasted until that evertricky thirtynine. Zann was our champion who kept going and going and going until I stopped since I felt 156 was sufficient. The leadership skills I noticed during various free play times tended to come from the four year olds and the kindergarteners. The younger age groups, especially the two year olds, tended to stick to themselves. The solitary playtime seemed to happen less and less as I observed the older age groups. Matt, the spaceship pilot, seemed to be an all around leader no matter what the scenario was. On the playground, Matt led a squadron of about seven kids up and down the slides, across the monkey bars and whereever else he chose to go. He would occasionally stop running around and he would proceed to give orders to each of his group. Most of the time, the children would accept and follow the orders without hesitation. Robby is the best example I could find for children that seem to be lacking in leadership skills. At the end of story time the teacher radomly picks a child and gives that the child the oppurtunity to decide whether boys go to the bathroom and girls go to the sink or vice versa. On this occassion, the teacher picked Robby. Robby showed reluctance or perhaps confusion when asked to lead the children. He finally did but only after a good amount of hesitation. On the playground Robby tends to stick with himself. At one point, he rode the tricycle around in a sluggish fashion. For the most part, Robby stayed in the gravel pit and played with buckets of gravel ignoring the kids that run around and over him. Hopefully this observation can give some insight of the preschool age group. Although this was only a sample, perhaps some conclusions can be drawn on the development and behavior of these children. f:\12000 essays\health & humanities (196)\ObsessiveCompulsive Behaviors.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Obsessive-Compulsive Behaviors "Compulsive" and "obsessive" have become everyday words. "I'm compulsive" is how some people describe their need for neatness, punctuality, and shoes lined up in the closets. "He's so compulsive is shorthand for calling someone uptight, controlling, and not much fun. "She's obsessed with him" is a way of saying your friend is hopelessly lovesick. That is not how these words are used to describe Obsessive- Compulsive Disorder or OCD, a strange and fascinating sickness of ritual and doubts run wild. OCD can begin suddenly and is usually seen as a problem as soon as it starts. Compulsives (a term for patients who mostly ritualize) and obsessives (those who think of something over and over again) rarely have rituals or thoughts about nuetral questions or behaviors. What are their rituals about? There are several possible ways to list symptoms of OCD. All sources agree that the most common preoccupations are dirt (washing, germs, touching), checking for safety or closed spaces (closets, doors, drawers, appliances, light switches), and thoughts, often thoughts about unacceptable violent, sexual, or crude behavior. When the thoughts and rituals of OCD are intense, the victim's work and home life disintigrate. Obsessions are persistant, senseless, worrisome, and often times, embarrassing, or frightening thoughts that repeat over and over in the mind in an endless loop. The automatic nature of these recurant thoughts makes them difficult for the person to ignore or restrain successfully. The essence of a Compulsive Personality Disorder is normally found in a restricted person, who is a perfectionist to a degree that demands that others to submit to his\her way of doing things. A compulsive personality is also often indecisive and excessively devoted to work to the exclusion of pleasure. When pleasure is considered, it is something to be planned and worked for. Pleasurable activities are usually postponed and sometimes never even enjoyed. With severe compulsions, endless rituals dominate each day. Compulsions are incredibly repetitive and seemingly purposeful acts that result from the obsessions. The person performs certain acts according to certain rules or in a stereotypical way in order to prevent or avoid unsympathetic consequences. People with compulsive personalities tend to be excessively moralistic, and judgmental of themselves and others. Senseless thoughts that recur over and over again appearing out of the blue; certain "magical" acts are repeated over and over. For some the thoughts are meaningless like numbers, one number or several, for others they are highly charged ideas-for example, "I have just killed someone." The intrusion into conscious everyday thinking of such intense, repetitive, and to the victim disgusting and alien thoughts is a dramatic and remarkable experience. You can't put them out of your mind, that's the nature of the obsessions. Some patients are "checkers," they check lights, doors, locks-ten, twenty or a hundred times. Others spend hours producing unimportant symmetry. Shoelaces must be exactly even, eyebrows identical to eachother. A case studied by the well-known art therapist, Judith Aron Rubin, Rubin tells of a young girl named Mary, who suffers from OCD, and how she drives her fellow waitresses frantic because she goes into a tailspin if the salt and pepper she has arranged in a certain order has been moved around. All of the OCD problems have common themes: you can't trust good judgment, you can't trust your eyes that see no dirt, or really believe that the door is locked. You know you have done nothing harmful but in spite of this good sense you must go on checking and counting. There are many, many common obsessions, of all of them the most common is called "washing" this involves the victim to have a constant feeling of conamination, dirt and\or grime all over their body. The book,The Boy Who Couldn't Stop Washing by Judith L. Rapoport describes a long, sad case of a young boy who spent three or more hours in the shower each day. The boy "felt sure" that there was some sticky substance on his skin. He thought of nothing else. Our normal functioning probably consists of constant uncountable checking, a sort of radar operation, that we could not do contiously and still act efficiently. Something has gone wrong with the process for obsessive compulsives, the usual shut-off such as "my hands are clean enough" or "I saw the gas was turned off on the stove" or "The door was locked." does not get through. Everyday life becomes dominated by doubts, leading to senseless repetition and ritual. Obsessive phobias tend to have distinct features. According to Issac Marks, "They are usually part of a variety of fears of potential situations themselves. Because of the vagueness of these possibilities, ripples of avoidance and protective rituals spread far and wide to involve the patients life style and people around him\her. Clinical examination usually discloses obsessive rituals not directly connected with the professed fear; instead the obsessive fear is part of a wider obsessive-compulsive disorder."(Marks,1969) "The sustained experience of obsessions and\or compulsions." make up what the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, calls Obsessive-Compulsive Disorder. It has also been called obsessional nuerosis. Psychiatrists have been fascinated by this disorder for over a hundred years. Priests have described symptoms like these for much longer than that.(A.P.A.,80) Children suffer from OCD with exactly the same symptoms as adults. Normally an early start in mental disorder is unusual. Other mental illnesses, such as depression or schitzophrenia often apear in a differant form in young children and in any case are much more rare in children than in adults. But with OCD it is the same at any age. In the book The Boy Who Couln't Stop Washing, there is a story of a fourteen-year-old girl who has been diagnosed with OCD. As she is talking to her psychiatrist she says, "I have really lost touch with myself and that is really frightening. I wish I could get the 'old Sally' back. I keep hoping it's just a dream and that I'll wake up and everything will be normal. I used to like who I was a lot, but now I feel I don't even know myself anymore. I have so many goals and dreams I would like to accomplish, but I know I will never acomplish them with OCD. I feel like I am in a mental labyrinth from which I can't escape. I hope I can get better." (Rapoport,'89,p.80) To quote the author and psychiatrist, Judith L. Rapoport, "The disease affects some of the most able, sensitive, and talented people I have met. Their otherwise normal ability to function, to become a good husband, wife, or friend makes working with obsessive-compulsive patients very rewarding and, when they are severely ill, very painful."(Rapoport,'89, p.3) A few individual cases of OCD have been reported in the medical literature over the past 150 years, but only recently have we learned of the large number of adolesence and adults who suffer with it. More than 4 million people in the United States suffer from its' disabling thoughts or rituals. Amazingly most of them keep their problem hidden. We are finding out that many of the adults who are being treated for it now went pretty much their whole life hiding the problem because they were too humiliated or did not want to be considered crazy and thown in a mental institution. In spite of the interesting individual cases of OCD in the past one hundred fifty years, there was not much work on treatment. There is little incentive to evaluate or develop new treatments for rare disorders. So up until the 1970's the recommended treatment was psychotherapy or psychoanalysis. Doctors made these suggestions for lack of an alternative, but severe cases and follow-up studies of adults could not show any advantadge for this treatment. The Best studied Drug to reduce or stop OCD,is called Anafranil. Anafranil was first put on the market in 1990. The side effects of Anafranil range from mild to severe. The most common side effects are dry mouth, constipation, and drowsiness. However a tremor, loss of sexual appetite, impotence-which is temporary until you stop taking the drug, and excessive sweating can be major problems. These are all side effects common to tricyclic anti-depressants-the group of which Anafranil belongs. In the most severe cases of OCD, psychosurgery was used regularly until the 1950s. With availability of other treatments psychosurgery is now a last resort. In some cases, however, this drastic treatment seems to work when everything else has failed. A few medical centers in Boston, London, and Stockholm, for example, will still perform limited operations using newer techniques. The two newer treatments, behavior therapy and drug treatment with Anafranil, both seem to have long-term benefits. Behavior therapists have followed up their patients for a year or two and the effect seems to last. Anafranil has not been as well studied in follow-up, but what studies have been done show that it too is helpful over at least two years. Even though Anafranil does work well it is not always nessesary. There are other aproaches. Some OCD's have gotten help from just "coming out of the OCD closet". Support groups have also been known to help. There is a wide variety of things you can do to help a person diagnosed with OCD. "Scientists have suggested that there may be a biological explanation for some obsessive compulsive disorders. There may be an imbalance in the frontal lobes of the brains of obsessive-compulsives that prevents the two brain regions from working together to channel and control incoming sensations and perceptions."(Boulougouris,1971) The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders requires at least five of the following symtoms to be characteristic of the persons functioning. In addition, the symptoms must cause some problems with personal or work life. "1. Restricted ability to express warm and tender emotions. 2. Perfectionism that interferes with overall ability to see the needs of a situation. 3. Insistence that others submit to the person's way of doing things without awareness of how this makes others feel. 4. Excessive devotion of work to the exclution of pleasure. 5. Indecisiveness to the point wher decisions are postponed avoided, or protracted. Assignments may not get done on time because of thinking about priorities. 6. Preoccupation with details, rules, lists or schedules to the extent that the major point of the activity is lost. 7. Overconscientiouness, scrupulousness, and inflexibility about moral or ethical matters. 8. Lack of generosity in giving time, money or gifts. 9. Inability to discard worn out or worthless objects." (A.P.A.,'80) So much is asked about where our everyday lives stop and OCD begins. The basis of Obsessive -Compulsive Disorder is still unknown. The evidence for a biological cause is compelling but unfortunately it is still necessary to speak of the biology of behavior in vague terms. The effect of a drug, and the normality of many of the families with an OCD kid makes the importance of "poor upbringing" as a cause of OCD uncertain to say the least. This is a disease that may be thought of as doubts gone wild. Patients doubt their very own senses. They cannot believe any reasurance of everyday life. Reassurance does not work. The notion that there is a biological basis for a sense of "knowing" has interesting philosophical implications. We are normally convinced that what we see and feel is truely there. If this is a "doubting disease," and if a chemical controls this sense of doubt, then is our usual, normal belief in what our everyday senses and common sense tell us similarly determined by our brain chemistry? f:\12000 essays\health & humanities (196)\osteoporosis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ OSTEOPOROSIS. Osteoporosis is a significant health problem that affects more than 25 million women in the United States and potentially 200 million worldwide. This disease is characterized by diminishing the structure of the skeleton (particular the "spongy" bone). This results in an increased risk of fracture. Osteoporosis develops silently over a period of years, eventually progressing to a point where a fracture can easily occur causing pain and disability. This disease is characterized by low bone mass and structural worsening of your bones, leading to bone fragility. There is an increased chances of damaging the hip, spine, and wrist . Twenty-five million Americans are affected by Osteoporosis, making it a major public health problem. 80% of those affected by osteoporosis are women. One out of every two women and one in five men have an Osteoporosis-related fracture. By age 75, one third of all men will be affected by osteoporosis. While osteoporosis is often thought of as an older person's disease, it can strike at any age. Osteoporosis is responsible for 1.5 million fractures annually, including: more than 300,000 hip fractures 500,000 vertebral fractures 200,000 wrist fractures Certain some people are more likely to develop Osteoporosis than others. These factors can increase your chances of getting osteoporosis. A family history of fractures in elderly women Use of certain medications Chronically low calcium intake Thin and/or small bones An inactive lifestyle Cigarette smoking Excessive use of alcohol Advanced age Women have approximately 10 to 25 percent less total bone mass at maturity than men, making them more open to osteoporosis. Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a fracture or a vertebra to collapse. Once your vertebrae collapses you would feel it in the form of severe back pain, loss of height, stooped posture or dowager's hump. Building strong bones, especially before the age of 35, can be the best defense against developing osteoporosis, and a healthy lifestyle can be critically important for keeping bones strong. So to help prevent osteoporosis: Eat a balanced diet rich in calcium Exercise regularly, especially weight-bearing activities Don't smoke Limit alcohol intake Although there is no cure for Osteoporosis, there are treatments available to help stop further bone loss and fractures. Estrogen replacement therapy is the most popular treatment for osteoporosis. Studies have shown that estrogen can prevent the loss of bone mass in women. Another treatment used by both women and men for Osteoporosis is Calcitonin. This drug slows bone breakdown and also can reduce the pain. Medical experts agree that Osteoporosis is highly preventable. Specialized tests called bone density tests can measure bone density in various sites of the body. With the information obtained from these bone mass measurements, physicians can assess an individual's bone density and predict the likelihood of fractures. However commitment to Osteoporosis research must be significantly increased. It is reasonable to say that with increased research, the future for definitive treatment and prevention of osteoporosis is very bright. Several medications like vitamin D are currently under investigation and may someday be used as a better treatment or even a cure for osteoporosis. Osteoporosis is a disease that can be prevented and treated. This is a disease in which bones become fragile and more likely to break. If not prevented , osteoporosis can progress painlessly until a bone breaks. Millions of people all over the world are at risk. While women are five times more likely than men to develop the disease, men also suffer from osteoporosis. Building strong bones, especially before the age of 35, can be the best defense against developing osteoporosis, and a healthy lifestyle can be critically important for keeping bones strong. There are some things you can do to make sure you wont get osteoporosis like exercise and a good diet. f:\12000 essays\health & humanities (196)\Our World In Medicine.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Our World In Medicine One of the most important factors about people's lives is the information of, the use of, and the growing knowledge of medicine. Medicine is a science that nations all over the world use. It is a science because it is based on knowledge gained through careful study and experimentation. Medicine is also an art form because it depends on how skillfully doctors and other medical workers apply their knowledge when dealing with patients.1 Medicine is one of the most respected professions. The two important goals of medicine are to save lives and to relieve suffering, which is why it is so respected. But the medical field is not open to anyone who wants to help. It takes many long years of college and medical school to get even a license to work with medicine.2 While some doctors are more important than others, almost all of them are on call twenty - four hour a day, seven days a week. Because they have to apply themselves to their job at all times, they are payed at very good wages. Human beings have been suffering from disease since they first appeared on the earth about two and one -half million years ago. Throughout most of this time, they knew little about how the human body works or what causes disease. But medicine has gone through many stages throughout history. In prehistoric times, people believed that angry gods or evil spirits caused disease. To cure the sick, the gods had to be pacified or the evil spirits driven from the body. In time, this task became the job of the first "physicians".3 The first - known surgical treatment was an operation called trephining. Trephining involved use of a stone instrument to cut a hole in a patient's skull. Scientists have found fossils of such skulls that date back as far as 10,000 years. Prehistoric people probably also discovered that many plants can be used as drugs. For example, the use of willow bark to relieve pain probably dates back thousands of years.4 Today, scientists know that willow bark contains the important ingredients that is included in making aspirin. In the Middle East, the Egyptians began making important medical progress. Around 2500 B.C., Egyptian physicians began to specialize. Some physicians treated only diseases of the eyes or teeth. Others specialized in internal diseases. Egyptian surgeons produced a textbook that told how to treat dislocated or fractured bones and as well as tumors, ulcers, and wounds.5 The civilization of ancient Greece was at its peak during the 400's B.C. Throughout this period, sick people flocked to temples dedicated to the Greek god of healing, Asclepius, seeking magical cures.6 But at the same time, the great Greek physician Hippocrates began showing that disease has only natural causes. He thus became the first physician known to consider medicine a science and art separate from the practice of religion. The Hippocratic oath, an expression of early medical ethics, reflects Hippocrates' high ideals.7 The Greek physician Galen made the most important contributions to medicine in Roman times. Galen performed experiments on animals and used his findings to develop the first medical theories based on scientific experiments. For this reason, he is considered the founder of experimental medicine. But because his knowledge of anatomy was based on animal experiments, Galen developed many false notions about how the human body works.8 During the Middle Ages, which lasted from the A.D. 400's to the 1500's, the Muslim Empire of Southwest and Central Asia contributed greatly to medicine. Rhazes, a Persian - born physician of the late 800's and early 900's, wrote the first accurate descriptions of measles and smallpox. Avicenna, an Arab physician of the late 900's and early 1000's, produced a medical encyclopedia called Canon of Medicine. It summed up the medical knowledge of the time and accurately described many known diseases. Avicenna's work became popular in Europe, where it influenced medical education for more than 600 years.9 The chief medical advances during the Middle Ages were the founding of many hospitals and the first university medical schools. In the 900's, a medical school was started in Salerno, Italy. It became the chief center of medical learning in Europe during the 1000's and 1100's. Other important medical schools developed after 1100. During the 1100's and 1200's, many of these schools became part of newly developing universities.10 A new scientific spirit developed during the Renaissance, 1300's to the 1600's. The laws against human dissection were totally relaxed during this period. As a result, the first truly scientific studies of the human body began.11 A French army doctor named Ambroise Paré improved surgical techniques to such an extent that he is considered the father of modern surgery. For example, instead of burning a wound to prevent infection, he developed the much more effective method of applying ointment and then allowing the wound to heal naturally.12 The scientific study of disease, called pathology, was developed during the 1800's. Rudolf Virchow, a German physician and scientist, led the development. Virchow believed that the only way to understand the nature of disease was by close examination of the affected body cells. He did important research in such diseases as leukemia and tuberculosis.13 Pasteur, a brilliant French chemist, proved that microbes are living organisms and that certain kinds of microbes cause disease. He also proved that killing specific microbes stops the spread of specific diseases. Koch, a German physician, invented a method for determining which bacteria cause particular diseases. Other research scientists followed the lead of these two pioneers. Pasteur's early work on bacteria convinced an English surgeon named Joseph Lister that germs caused many of the deaths of surgical patients. In 1865, Lister began using carbolic acid, a powerful disinfectant, to sterilize surgical wounds. But this method was replaced by a more efficient technique known as aseptic surgery. This technique involved keeping germs away from surgical wounds in the first place instead of trying to kill germs already there.14 Advances in many fields of science and engineering have created a medical revolution in the 1900's. For example, the discovery of X-rays by the German physicist Wilhelm Roentgen enabled doctors to see inside the human body to diagnose illnesses and injuries. The discovery of radium in 1898 provided a powerful weapon against cancer.15 The development of new vaccines has helped control the spread of such infectious diseases as polio, hepatitis, and measles. During the 1960's and 1970's, the World Health Organization conducted a vaccination program that eliminated smallpox from the world. Much progress in modern medicine has resulted from engineering advances. Engineers have developed a variety of instruments and machines to aid doctors in the diagnosis, treatment, and prevention of diseases and disorders. Some of these devices have helped surgeons develop amazing new lifesaving techniques, especially in the fields of heart surgery and tissue transplants.16 Throughout many, many centuries, medicine has been used in hundreds of different forms. But the main goal of every different form was the same, to help the diseased and unhealthy. Every passing day, another scientist or doctor discovers another breakthrough in science and medicine. In years to come, we will have cures to incurable diseases, and people will be living ten to twenty years longer then they are today. Medicine provides us with the needs and hopes for the future, as our technology makes the path for us to follow. f:\12000 essays\health & humanities (196)\Parental Pressure.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Parental Pressure within High School Students I. I became interested in this topic because my entire academic life has been filled with pressure from my parents. This pressure was mainly in school and grades, and in high school, the amount of pressure increased dramatically. This is because my parents now realized that everything in high school counts towards college. When I first came to high school, my grades were not as good as they were in middle school. I needed a little time to adapt to high school before I could improve my grades. During this time, my parents became upset because I brought home a report card that was not as good as they were expecting. Then I really noticed the pressure getting higher and higher. I did not only notice this with me, but I noticed this with many of my friends. I heard phrases like "My parents are going to kill me" and "I'm going to be grounded for 10 years" many times so when the opportunity to do research on this came up, I chose this as my subject. II. How does parental pressure influence students in high school? If there is an influence, is it positive or negative? I would like to do research on this because it raised my curiosity. For me personally, I do better in school if I am calm and have little pressure, but there might be students out there at Ramapo High School that think differently. These are some of the things that I will try to find out through this I-Search. III. At the beginning of my search, I had a really hard time finding secondary sources. First, I went to the school library. Since the school library has this computer program called BELS, there was no need to go to the other libraries. BELS is a program that lists all the books in Franklin Lakes, Wyckoff, and Oakland. It is a network that unites the two public libraries and the one in Indian Hills. I then went to an article search. I had no luck here either. When I went home, I went on America Online to try to find some articles or any secondary sources. I went to the article search and still found nothing. After a few days, I asked the school librarian to help me find some books. She guided me to a section that had books about social problems. Luckily, I found two books on families and parents. These were two good books, but I still needed at least one more to fulfill my requirement. I went to the Special Services department and talked to a person there. She gladly offered help. She said that she would look through her stuff and try to find what she could on this subject. Then she told me to come back after school to pick up whatever she had. I returned after the school day ended and went back to the Special Services department. She was waiting there with two books and an article. Although I found that one of the books that I was given was not a real good help, the others were. My secondary sources were finished and now I had to move on to my primary sources. These were much easier because I did not need to search for anything. I interviewed two classmates during some free time I had in class, and put out a survey. These also helped a lot in giving me information I could use. Since I had all of my sources, I then proceeded with the notecards. IV. Do parents of high school students put too much pressure on their children? The students would probably say yes, and the parents would probably say no. Parents would probably say that they just want the best for their children. Sometimes, though, this "good cause" leads into disaster when the parents take it too far. This could be by the fault of the parent or the child. This means that either the child provokes the parent by doing badly in school, or the parents do not become satisfied with the child's achievement and takes over their lives. When the parents concentrate on grades alone, they become like a dictator and not a friend. They do not care about anything else such as social problems and sports (Webb pg.24). This causes the child to overachieve. This means that the child thinks that the only way he/she can get the affection and respect of his/her parents is to bring home good grades. At this point, anything that does not deal with grades or academics is worthless to the child, and furthermore the child does not care (Webb pg.25). When this happens, the child focuses so much on grades, he/she misses out on being a normal teenager. This includes going out with friends, dances, hobbies, and sports. Also, the child feels lonely and ends up having to practice growing up and being an adult by herself because his/her parents do not care (Webb pg.26). Sometimes parents get so caught up with their child's grades that they always "check over" their homework when all they are doing is doing it for them. The teachers notice this and punish the student and not the parent (Gaillard). Klagsbrun(1976) states, "Suicidal students are seldom satisfied with their grades, no matter how high they are." Parents can also put pressure on their child even when praising their good grades and efforts. For example, when a child does extremely well in one subject, the parents become happy and praise the child. At the same time, the child is doing poorly in another subject but is just afraid to tell his/her parents because it might make them upset. This pressures the child and he/she does not know what to do (Rubin pg.143). Pressure can also be deadly. Here are two cases. First, a fifteen year old honors student (and an Eagle Scout) stood up in the middle of his English class and shot himself. He did this because he was given a notice, that was to be signed by his parents, saying that he was doing badly in class (Guetzloe pg.65). The second case is another teenage suicide. A ten year old boy received bad grades on his report card for the third time. He left his report card at school knowing that if he brought it home he would be punished. When he went home, without his report card, his father got suspicious. He went to the school to pick it up, and in the half hour that he was gone, the little boy shot himself. His brother remembered him saying that he could not stand the idea of a whipping (Guetzloe pg.63). There have been many more suicide incidents and Seiden (1966) suggested that "increasing pressure for academic achievement would lead to an increase in suicide rate among the student population" (Guetzloe pg.65). In a recent survey of sophomores in Ramapo High School, more than half stated that they had a lot of pressure relating to school. Some came from parents and some came from themselves. A person answering this survey stated, "Most of my pressure about grades and school and college comes from myself. Last year, the pressure was so bad that I made myself sick." According to Garfinkel, 3 of 10 leading causes of stress in adolescents are school related and 1 of 10 suicide attempts is related to a crises at school (Guetzloe pg.64). Also, in this survey, 15 of 43 students have siblings that do better in school than they do, and 10 of those students have parents expecting them to do as well as his/her sibling. Kelly Leaman and Tyler Mills were both interviewed and both students stated that they have families that do extremely well in school. Kelly states, "My whole family is smart, and they all go (or went) to good colleges." In the issue of pressure affecting their school performance, Tyler said that he has a good amount of pressure and that without it, he would probably do worse. Kelly on the other hand, said that she would do a lot better if she had less pressure from her parents. Being a good parent means being there and having confidence in a child. A parent should provide outstretched arms for a safe place when the child might need it. The child should be relaxed and should be enjoying school. Maybe the child will get good grades because he/she wants to (Webb pg.25). Works Cited Gaillard, Lee "Hands Off Homework?" Education Week 14 December 1994 Guetzloe, Elennor C. Youth Suicide: What the Educators Should Know. New York: The Council for Exceptional Children, 1989. Leaman, Kelly - interview Mills, Tyler - interview Rubin, Dr. Jeffrey and Dr. Carol When Families Fight. New York: William Morrow and Company, Inc. 1989 Webb, Margot Coping with Overprotective Parents. New York: The Rosen Publishing Group, Inc. 1990 f:\12000 essays\health & humanities (196)\Pornography.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ In the late Seventies, America became shocked and outraged by the rape, mutilation, and murder of over a dozen young, beautiful girls. The man who committed these murders, Ted Bundy, was later apprehended and executed. During his detention in various penitentiaries, he was mentally probed and prodded by psychologist and psychoanalysts hoping to discover the root of his violent actions and sexual frustrations. Many theories arose in attempts to explain the motivational factors behind his murderous escapades. However, the strongest and most feasible of these theories came not from the psychologists, but from the man himself, "as a teenager, my buddies and I would all sneak around and watch porn. As I grew older, I became more and more interested and involved in it, (pornography) became and obsession. I got so involved in it, I wanted to incorporate (porn) into my life, but I couldn't behave like that and maintain the success I had worked so hard for. I generated an alter-ego to fulfill by fantasies under-cover. Pornography was a means of unlocking the evil I had buried inside myself" (Leidholdt 47). Is it possible that pornography is acting as the key to unlocking the evil in more unstable minds? According to Edward Donnerstein, a leading researcher in the pornography field, "the relationship between sexually violent images in the media and subsequent aggression and . . . callous attitudes towards women is mush stronger statistically than the relationship between smoking and cancer" (Itzin 22). After considering the increase in rape and molestation, sexual harassment, and other sex crimes over the last few decades, and also the corresponding increase of business in the pornography industry, the link between violence and pornography needs considerable study and examination. Once the 2 evidence you will encounter in this paper is evaluated and quantified, it will be hard not to come away with the realization that habitual use of pornographic material promotes unrealistic and unattainable desires in men that can lead to violent behavior toward women. In order to properly discuss pornography, and be able to link it to violence, we must first come to a basic and agreeable understanding of what the word pornography means. The term pornography originates from two Greek words, porn, which means harlot, and graphein, which means to write (Webster's 286). My belief is that the describe, in literature, the sexual escapades of women of pornography has grown to include any and all obscene literature and pictures. At the present date, the term is basically a blanket which covers all types of material such as explicit literature, photography, films, and video tapes with varying degrees of sexual content. Now that pornography has been defined in a fashion mirroring its content, it is now possible to touch upon the more complex ways a community, as a society, views or defines it. Some have said it is impossible for a group of individuals to form a concrete opinion as to what pornography means. A U.S. Supreme Court judge is quoted as saying, "I can't define pornography, but I know it when I see it" (Itzin 20). This statement can be heard at community meetings in every state, city, and county across the nation. Community standards are hazy due to the fact that when asked what pornography is to them, most individuals cannot express or explain in words what pornography is, therefore creating confusion among themselves. Communities are left somewhat helpless in this matter since the federal courts passed legislation to keep pornography available to adults. The courts assess that to ban or censor the material would be infringing on the public's First Amendment Right (Carol 28). Maureen O'Brien quotes critics of a congressionally terminated bill, the 3 pornography Victim's Compensation Act, as saying "That if it had passed, it would have had severely chilling effects on the First Amendment, allowing victims of sexual crimes to file suit against producers and distributors of any work that was proven to have had 'caused' the attack, such as graphic material in books, magazines, videos, films, and records" (Carol 7). People in a community debating over pornography often have different views as to whether or not it should even be made available period, and some could even argue this point against the types of women used in pornography: "A for greater variety of female types are shown as desirable in pornography than mainstream films and network television have ever recognized: fat women, flat women, hairy women, aggressive women, older women, you name it" (Carol 25). If we could all decide on just exactly what pornography is and what is acceptable, there wouldn't be so much debate over the issue of censoring it. The bounds of community standards have been stretched by mainstreaming movies, opening the way even further for the legalization of more explicit fare (Jenish 53). In most contemporary communities explicit sex that is without violent of dehumanizing acts is acceptable in American society today. These community standards have not been around very long. When movies were first brought out, they were heavily restricted and not protected by the First Amendment, because films then were liked upon only as diversionary entertainment and business. Even though sexual images were highly monitored, the movie industry was hit so hard during the Great Depression that film-makers found themselves smeaking in as much sexual content as possible, even then they saw that 'sex sells' (Clark 1029). Films were highly restricted throughout the 30's, 40's, and 50's by the industry, but once independent films of the 60's such as: "Bonnie and Clyde" and "Whose afraid of Virginia Wolfe?" (Clark 1029-1030), both with explicit language, sexual innuendo, and 4 violence started out-performing the larger ''wholesome' production companies, many of the barriers holding sex and violence back were torn down in the name of profit. Adult content was put into movies long ago, we have become more immune and can't expect it to get any better or to go way. Porn is here for good. Pornography is a multi-million dollar international industry, ultimately run y organized crime all over the world, and is produced by the respectable mainstream publishing business companies (Itzin 21). Although the publishing companies are thought to be 'respectable', people generally stereotype buyers and users of pornographic material as 'dirty old men in trenchcoats', with disposable income (Jenish 52). Porno movies provide adults of both genders with activities they normally wouldn't get in everyday life, such as oral pleasures or different types of fetishes. Ultimately adult entertainment is just a quick-fix for grown-ups, as junk-food would be for small children. Pornography's main purpose is to serve as masturbatory stimuli for males and to provide a sexual bent. Although in the beginning, society was it as perverted and sinful, it was still considered relatively harmless. Today there is one case study, standing out from the rest, that tends to shatter this illusion. The study done by Monica D. Weisz and Christopher M. Earls used "eighty-seven males . . . that were randomly shown one of four films", by researchers William Tooke and Martin Lalumiere: "Deliverance, Straw Dogs, Die Hard II, and Days of Thunder", for a study on how they would react to questions about sexual violence and offenders after watching. In the four films there is sexual aggression against a male, sexual aggression against a female, physical aggression, and neutrality-no explicit scenes of physical or sexual aggression. Out of this study the males were more acceptable of interpersonal violence and rape myths and also more attracted to sexual aggression. These same males were less sympathetic to rape victims and were noted less likely to 5 find a defendant guilty of rape (Jenish 71). These four above mentioned movies are mainstreamed R-rated films. If a mainstream movie can cause this kind of distortion of value and morality, then it should become evident that continuous viewing/use of pornographic films depicting violent sex and aggression could lead vulnerable persons into performing or participating in sexual violence against their partners or against a stranger. Bill Marshall, psychology professor at Queen's University and director of a sexual behavior clinic in Kingston, interviewed one-hundred and twenty men, between the years 1980 and 1985, who had molested children or raped women. In his conclusion he found that pornography appeared to be a significant factor in the chain of events leading up to a deviant act in 25% of these cases (Nicols 60). Rape myth is a term pertaining to people's views on rape, rapists, and sexual assaults, wherein it is assumed that the victim of a sexual crime is either partially or completely to blame (Allen 6). To help understand the rape myth a "Rape Myth Acceptance Scale" was established, which lists some of the most prominent beliefs that a person accepting the rape myth has. They are as follows: 1. A woman who goes to the home or apartment of a man on their first date implies that she is willing to have sex. 2. One reason that women falsely report a rape is that they frequently have a need to call attention to themselves. 3. Any healthy woman can successfully resist a rapist if she really wants to. 4. When women go around braless or wearing short skirts and tight tops, they are just asking for trouble (Burt 217). 6 Pauline Bart reports that studies held simultaneously at UCLA and St. Xavier College on students, demonstrate that pornography does positively reinforce the rape myth. Men and women were exposed to over for hours of exotic video (of varying types; i.e. soft, hard core, etc.) and then asked to answer a set of questions meant to gage their attitudes of sex crimes. All the men were proven to be more accepting to rape myths, and surprisingly, over half of the women were also (Burt 123). Once again, the women in these films were portrayed as insatiable and in need of constant fulfillment. After so much exposure to women in this light from films and books, it is generally taken for granted that women should emulate this type of behavior in real life (Burt 125). In regards to pornography perpetuating violent acts toward women, pornography defenders claim that the use of pornographic material can act a s a cathartic release, actual lessening the likelihood of males committing violent acts. The reasoning is that the pornography can substitute for sex and that the 'want' to commit sexual crimes is acted out vicariously through the pornographic material (Whicclair 327). This argument, however, does not explain the crimes committed by serial killers like Ted Bundy and John Wayne Gacey, who regularly viewed pornography during the lengths of their times between murders and rapes (Nicols 70). By saying the pornography would reduce harm to women through cathartic effects, pornography defenders display a large lack in reasoning because through their argument the rise in the production of pornography would have led to a decrease in sexual crimes, but as has been shown previously, that simply is not true. Pornographers and pornography defenders proclaim that the link between pornography and violence is exaggerated and that the research linking pornography to sexual crimes is inconclusive. They state that the fundamentals of sex crimes are found inherently in the individuals and that the sexual permissiveness of American society 7 cannot be blamed on the increase of pornography's availability (Jacobson 79). David Adams, a co-founder and executive director of Emerge, a Boston counseling center for male batterers, states, "that only a minority of his clients (perhaps 10 to 20 percent) use hard-core pornography. He estimates that half my have substance abuse problems, and adds that alcohol seems more directly involved in abuse the pornography" (Kaminer 115). The statement made by Adams and the view that pornography does not contribute to the act of sex crimes is heavily outweighed, however, by the various studies connecting violence and pornography. Bill Marshall's observations on his patients and the examples of individual crimes originating from pornography, show this acclimation to be invalidated. Some also say that attacks on pornography merely reflect the majority of feminist's disdain for men, cynically stating that people who fear pornography think of all men as potential abusers, whose violent impulses are bound to be sparked by pornography (Kaminer 114). Researcher Catherine MacKinnon, says that "pornography works as a behavioral conditioner, reinforcer, and stimulus, not as idea or advocacy" (Kaminer 114). However, this idea is proven to be false by the use of pornography in and by the Serbian military. This example shows that pornography does advocate sex crimes and that ideas of sexual violence are able to be stemmed from the viewing of pornography. From its inception, in most cases, pornography is a media that links sexual gratification and violence together. This fact can only lead a rational mind to the conclusion that a chain of events will begin, combining sex and violence further in the minds of those who watch pornography and will ensure and unhealthy attitude towards women and their sexual identities. Only through discussion and individual action can the 8 perpetuation of the negative impacts of pornography be swept from the closets and dark corners of the American household. 9 Works Cited Allen, Mike. "Exposure to Pornography and Acceptance of Rape Myths." Journal of Communication. Winter, 1995: 5-21. Burt, M. "Cultural Myths and Supports for Rape." Journal of Personality and Social Psychology. 38 (1980): 217-230. Carol, Avedon. "Free Speech and the Porn Wars." National Forum. 75.2 (1985): 25-28. Clark, Charles S. "Sex, Violence, and the Media." CQ Researcher. 17 Nov. 1995: 1019-1033. Itzin, Catherine. "Pornography and Civil Liberties." National Review. 75.2 (1985): 20-24. Jacobson, Daniel. "Freedom of Speech Acts? A Response to Langton." Philosophy & Public Affairs. Summer 1992: 65-79. Jenish, D'Arcy. "The King of Porn." Maclean's. 11 Oct. 1993: 52-56. Kaminer, Wendy. "Feminists Against the First Amendment." The Atlantic Monthly. Nov. 1992: 111-118. Leidholdt, Margaret. Take Back the Night: Women on Pornography. New York: William Morrow and Company, Inc., 1980. Nicols, Mark. "Viewers and Victims." Newsweek. 10 Aug. 1983: 60. Webster's Dictionary. Miami, Florida. P.S.I. & Associates. 1987: 286. Whicclair, Mark R. "Feminism, Pornography, and Censorship." Contemporary Moral Problems. ed. James White. Minneapolis/St. Paul, MN: 1994. Pornography - - Sex or Subordination? Health and Hygiene 24 February, 1997 f:\12000 essays\health & humanities (196)\POSTTRAUMATIC STRESS DISORDER 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ POSTTRAUMATIC STRESS DISORDER Posttraumatic Stress Disorder is a condition from which nearly 10% of Americans suffer. It, unlike other afflictions, is associated with a wide variety of circumstances. Many war veterans suffer from Posttraumatic Stress Disorder. However, a new group of people are quickly emerging as common suffers of Posttraumatic Stress Disorder-sexually abused children. Posttraumatic Stress Disorder is a prevalent problem associated with children who are victims of sexual assault. Posttraumatic Stress Disorder is classified as an anxiety disorder under the Diagnostic and Statistical Manual of Disorders (DSM-III). The diagnoses for Posttraumatic Stress Disorder was not formally diagnosed as part of DSM-III until 1980. According to Famolaro, "the diagnoses of Posttraumatic Stress Disorder requires: (a) experience of a significant traumatic events; (b) re-experiencing of the trauma in one of several different thought, emotional, or behavioral forms; (d) persistent symptoms of increased arousal, Particularly when exposedto stimuli concretely or symbolically reminiscent of the trauma; (e) symptoms lasting at least one month. (Famolaro, Maternal and Child Posttraumatic... 28)". Children are now becoming realized as significant sufferers of Posttraumatic Stress Disorder. Posttraumatic Stress Disorder is particularly bad for children under the age of 11, because they lack many of the skills needed to protect themselves. Furthermore, this vulnerability is enhanced when the child is exposed to any maltreatment. According to recent studies, "Posttraumatic Stress Disorder is a common sequella of severe or chronic maltreatment of children, particularly among sexually maltreated children ( Famularo, Symptom Differences... 28)". Posttraumatic Stress Disorder can be caused if the child is exposed to just one traumatic episode (rape, witnessing a violent crime, physical abuse); However, the child will become more susceptible to Posttraumatic Stress Disorder if the maltreatment continues. Moreover, a child is most likely to suffer from symptoms associated with Posttraumatic Stress Disorder when sexual assault is involved(28). Because children have not yet developed cognitively emotionally and are very immature, they are likely candidates to develop symptoms related to Posttraumatic Stress Disorder. As a child matures he/she becomes better equipped to deal with and prevent contributing factors to the eventual suffering from Posttraumatic Stress Disorder. Up to age two, young children can recreate stressful events and even imagine such events recurring; However, the mind is not developed enough to identify, anticipate, or prevent future traumatic occurrences. At age three, children cannot, "distance themselves, in time, appreciate roles and differences in behavior, access situation, or adopt nonegocentric causality (Saigh 189)". This flaw opens them up to the impact of trauma because the child cannot anticipate and protect themselves. By age four, children have the ability to protect themselves by avoiding traumatic encounters. They also have the ability to suppress their anxiety when it becomes difficult to cope with. Because children do not have this ability any earlier they are vulnerable to physical and sexual assault. Children continue as such until they become concrete operational at about age six or seven (190). Children who have been sexually abused develop many of the syndromes associated with Posttraumatic Stress Disorder, some of which are, the inability to establish normal relationships with adults and peers, to make a normal transition from adolescence to adulthood, as well as to develop skills required to progress in school. However, this was not the case with all sexually assaulted children. Walder states, "not all those so exposed will develop a Posttraumatic Stress Disorder reaction; some may have a certain "hardiness" that helps them cope without any noticeable residual effects while others may have a severe psychological reaction that renders them unable to function (Walker 130)." Knowledge of sexual assaults has recently become more common. Random surveys of adults indicate that approximately 28% of women and 16% of men were victims of sexual abuse before the age of sixteen (Valentier 455). The nature of the abuse stretched from fondling to sexual intercourse committed by an adult that was five years older than the victim (Wolf et al). Women are more often the victims of child sexual assault then men. According to John B. Murry, women are the victims of child hood sexual abuse at a ratio of 10:1 over men (Murry 658). Furthermore, children of lower income families are also common victims of sexual assault. But, as Murry points out, sexual abuse occurs in all types of families regardless of their income; and, sexual assaults are usually committed by a member of the family. It is difficult to get an accurate record of the actual number of children that have been sexually abused. Many cases never come to light and because of differences in definitions of sexual assault, some cases are missed.(658). Researchers have begun to explore the concept of Posttraumatic Stress Disorder with children and adults that were victims of sexual assault. Many times people associate particular events with particular stimuli. For example, certain orders, colors, sounds, and people can trigger a memory of a past event. This is more true for victims of sexual assault. According to Wolf, Sas, and Wekerle, "traumatic episodes become associated with particular eliciting stimuli and can lead to maladaptive or a typical reactions. Such conditioning can play an important role in the formation of children's adjustment disorders subsequent to sexual abuse (Wolf et al 38)." Because people do not anticipate an abusive episode there are usually things the victim can not control. Sexual abuse is just such a stressful event that will produce a form of a coping reaction. Because children are impressionable the perpetrator may consult, threaten of confuse the child to confession. Child victims of child sexual assault are also tortured by nightmares, recurring images of the event and troubling memories. "Based on interviews with children who have been exploited by adults through sex rings and pornography, 65 of 60 children reported intrusive thoughts, flashbacks, and nightmares. Physical symptoms (eg. Somatic complaints, sleep problems, excessive crying) and greater social withdraw and distrust of others were also noted among a sizeable proportion of this sample (Wolf et al 39)." Posttraumatic Stress Disorder is diagnosed with the Posttraumatic Stress Disorder Symptom Checklist. The test consists of a list of 43 "adjustment problems" with 23 items spanning the range of symptoms characterizing Posttraumatic Stress Disorder as defined in the DSM-III Categories for Posttraumatic Stress Disorder. Participants were considered Posttraumatic Stress Disorder positive if they indicated on the test that they had reexperienced the traumatic event, became avoident, and had increased arousal. The test also indicated whether or not the participant had a "moderate problem" or "partial" Posttraumatic Stress Disorder (Rowan 55)." In one study using the PTSD symptom checklist on 42 sexually abused children, 64% of the participants were considered PSD"positive", with another 19% meeting the criteria for "partial" PTSD(56)." The sample of nighty children comprised of 21 boys and 69 girls. The average age was 12.4 years old. Based on the most severe forms of abuse reported by these children, 52.2% had alleged sexual touching (including fondling of genitals, masturbation, 34.4% reported oral, anal, or vaginal intercourse with the offender, 10% reported attempted or simulated intercourse, and the remaining 3,3% reported being the victim of indecent exposure. Out of the sample, 44.7% had been abused only once, 32.9% of the sample were abused two to ten times, 7.1% were abused ten to twenty times, and 15.3% more than twenty times. Almost all alleged perpetrators were persons known to the child, 54.4% were non-family members, 25.6% were abused by a parent or stepparent, 20% were abused by a member of the extended family or a stranger (Findelnor 1406). The results of the test indicated that of the ninety children tested, 44 showed positive signs of PTSD and 46 did not. Of the 44 children testing positive, 49.8% self-reported showing total fear, 53.2% indicated fears of abuse, 57.7% showed anxiety ,and 59.3% felt depressed. Guilt and self-blame were also diagnosed at 25% and 11% respectively. Parents of the 44 children that tested positive, 64.2% internalized their anxiety while 61.5% externalized (140). In a separate study done by Famularo, he evaluated a test group for both acute and chronic PTSD. Sexually abused children which had an onset of symptoms within six months of the abuse and a duration of symptoms lasting longer than six months were diagnosed as having acute PTSD. Conversely, sexually abused children with symptoms lasting longer thatn six months were diagnosed with chronic PTSD. Twenty-four of the 28 sexually abused children tested showed evidence of either acute or chronic symptoms of PTSD. Of this group 3.1% had recurrent intrusive recollections and 3.33% recreated the trauma in their play. 2.61% experienced nightmares, 3.33% of the group acted as if the event were occurring. Distress of exposure to symbolic real re-exposure was experienced by 2.1% of the children. 3.49% of the victims avoided thoughts related to the event and activities that arouse recollections of the event. Furthermore, 1.8% of the children could not recall aspects of the trauma. 3.2% demonstrated a diminished interest in games and recreational activities. 16.3% of those tested suffered regression. Of these victims, 3.14% detached and estranged themselves from others. Sadly, 2.61% of these traumatized children exhibited and expressed the belief that their lives would be short. While 2.9% felt that life was going to be difficult and long(144). Until recently, sexually abused children were never studied for symptoms of PTSD. As the aforementioned case studies suggest, it as a problem that deserves attention. These children do suffer the symptoms of PTSD and should be diagnosed and treated accordingly. This could be difficult as many instances of sexual abuse remain unreported; however, their problems are real and deserve the help that further research could facilitate. f:\12000 essays\health & humanities (196)\posttraumatic stress disorder.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ POSTTRAUMATIC STRESS DISORDER Posttraumatic Stress Disorder is a condition from which nearly 10% of Americans suffer. It, unlike other afflictions, is associated with a wide variety of circumstances. Many war veterans suffer from Posttraumatic Stress Disorder. However, a new group of people are quickly emerging as common suffers of Posttraumatic Stress Disorder-sexually abused children. Posttraumatic Stress Disorder is a prevalent problem associated with children who are victims of sexual assault. Posttraumatic Stress Disorder is classified as an anxiety disorder under the Diagnostic and Statistical Manual of Disorders (DSM-III). The diagnoses for Posttraumatic Stress Disorder was not formally diagnosed as part of DSM-III until 1980. According to Famolaro, "the diagnoses of Posttraumatic Stress Disorder requires: (a) experience of a significant traumatic events; (b) re-experiencing of the trauma in one of several different thought, emotional, or behavioral forms; (d) persistent symptoms of increased arousal, Particularly when exposedto stimuli concretely or symbolically reminiscent of the trauma; (e) symptoms lasting at least one month. (Famolaro, Maternal and Child Posttraumatic... 28)". Children are now becoming realized as significant sufferers of Posttraumatic Stress Disorder. Posttraumatic Stress Disorder is particularly bad for children under the age of 11, because they lack many of the skills needed to protect themselves. Furthermore, this vulnerability is enhanced when the child is exposed to any maltreatment. According to recent studies, "Posttraumatic Stress Disorder is a common sequella of severe or chronic maltreatment of children, particularly among sexually maltreated children ( Famularo, Symptom Differences... 28)". Posttraumatic Stress Disorder can be caused if the child is exposed to just one traumatic episode (rape, witnessing a violent crime, physical abuse); However, the child will become more susceptible to Posttraumatic Stress Disorder if the maltreatment continues. Moreover, a child is most likely to suffer from symptoms associated with Posttraumatic Stress Disorder when sexual assault is involved(28). Because children have not yet developed cognitively emotionally and are very immature, they are likely candidates to develop symptoms related to Posttraumatic Stress Disorder. As a child matures he/she becomes better equipped to deal with and prevent contributing factors to the eventual suffering from Posttraumatic Stress Disorder. Up to age two, young children can recreate stressful events and even imagine such events recurring; However, the mind is not developed enough to identify, anticipate, or prevent future traumatic occurrences. At age three, children cannot, "distance themselves, in time, appreciate roles and differences in behavior, access situation, or adopt nonegocentric causality (Saigh 189)". This flaw opens them up to the impact of trauma because the child cannot anticipate and protect themselves. By age four, children have the ability to protect themselves by avoiding traumatic encounters. They also have the ability to suppress their anxiety when it becomes difficult to cope with. Because children do not have this ability any earlier they are vulnerable to physical and sexual assault. Children continue as such until they become concrete operational at about age six or seven (190). Children who have been sexually abused develop many of the syndromes associated with Posttraumatic Stress Disorder, some of which are, the inability to establish normal relationships with adults and peers, to make a normal transition from adolescence to adulthood, as well as to develop skills required to progress in school. However, this was not the case with all sexually assaulted children. Walder states, "not all those so exposed will develop a Posttraumatic Stress Disorder reaction; some may have a certain "hardiness" that helps them cope without any noticeable residual effects while others may have a severe psychological reaction that renders them unable to function (Walker 130)." f:\12000 essays\health & humanities (196)\potty training a study in human behavior.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Azrin, Nathan,Ph.D. & Foxx, Richard, M., Ph.D. Toilet Training In Less Than a Day. New York: Pocket Books, 1974. The Trials of Toilet Training Toilet training is difficult for both parent and child. Based on the research of two psychologists, Nathan Azrin and Richard Foxx, the average child can be fully trained in less than four hours. They began their training with mentally handicapped adults and successfully taught 95% in three days. With the added emphasis on language and verbal rehearsal they attempted to teach children and were astounded at the results. Their methods eliminate the fear damaging the child's psyche by making toilet training a pleasant experience. The child is not simply toilet "trained", he is toilet "educated", that is, the complete process from knowing it's time to emptying the pot and flushing the waste down, all unsupervised. Any parent would agree, this is incredible. They use a combination of the same principals used in Practical Applications of Psychology. The overall objective is to teach the child to toilet himself with the same independence as an adult without the need for reminders, continued praise, or assistance. This method is rapid because of the variety of learning techniques. Learning by imitation, learning by teaching, a partial reinforcement schedule with rewards that increase the need and the negative reinforcement of disapproval are all employed. Children learn best by imitation and teaching with the aid of a hollow doll. The child gives the doll a drink then is told the doll has to "peepee" and he must help her. After the child assists in removing the doll's pants, the liquid is released. The child must observe the flow of liquid. into the potty chair. The adult and the child then praise the doll and the child then assists the doll in redressing and emptying the pot in the standard toilet and flushes. Then the child is instructed to ask is the doll is dry and feel her pants. If they are dry the doll gets a treat. The child is then asked if he is dry; if he is, he can then eat the doll's treat. After two or three drills, distract the child and cause and 'accident' by spilling some liquid on the doll's pants. When the child discovers the wetness, use instructions and guidance to help the child correct the doll. First, let the doll know he is displeased, "Big girls don't wet their pants." Second, the child helps the doll practice again on the potty then back to the scene of the accident. Since the pants will still be wet, this can be continued three times. Then have the child feel his own pants, and if they are dry he is rewarded with a drink. The child then assists the doll in changing her pants. The doll demonstration trials are continued until the child understands all the steps; usually less than an hour. When questioning the child, begin with an instruction, "Go to the potty." After a few times, switch to "Do you have to potty?" to a general statement, "Where do you potty?" to "Are your pants dry?" which is not a reminder, but a dry pants inspection. To increase motivation, use all types of rewards: Hugging, smiling, clapping, verbal praise, snacks, drinks and friends or family members who care. Always tell the child why you are praising him. In the beginning, show approval at the start of an act to encourage the next step as done with shaping, then as he progresses show approval only for the completion. Praise is further limited to dry pants inspections, since this is the overall objective. Also, as you see the child needing less manual guidance, stand further and further away. Resist the urge of further assisting the child. When an accident does occur, spend a few seconds verbally displaying disappointment,"No, your pants are wet, you have to practice some more." Practice twice going to the pot from the scene of the accident and pulling down pants at a quick pace, then raising them again. Practice another eight times from different locations, so he will remember to rapidly use the bathroom, no matter where he is. The next step is the inspection. Since he has not changed yet, they are wet. Tell him again that you and his heros are disappointed. Repeat ten times. Have the child take off the wet pants, put them in the laundry, get a new pair, put them on and then clean up any leakage with a sponge. Love your child, but disapprove of wetting. If the procedure does not work with the child, continue where you left off the previous day. In any event, continue dry pants inspections until no accidents occur for a week. Accidents will happen because of new distractions, use the same corrective procedures previously discussed. f:\12000 essays\health & humanities (196)\Premature Infancy.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Premature Infancy Premature babies, otherwise known as preterm babies, or preemies, are babies that are born earlier than the full-term of thirty-eight to forty-two weeks of pregnancy. These babies are generally born between the twentieth and thirty-eighth week. Almost 250,000 babies, nearly seven percent of newborns, are premature(Golant 4). Prematurity, even with all the advances in technology, is still a major cause of fetal and neonatal death. Actually, around seventy-five percent of perinatal deaths are due to a number of problems associated with prematurity(Freeman 232). Premature babies are very weak and defenseless, and need to be hospitalized. One reason for this is that a baby may become startled into shock by a loud sound or even bright light. This occurs because many babies have fully-developed senses and underdeveloped organs, which may become a problem, since the brain may not be developed well enough to be able to distinguish these different senses, which causes the baby to panic and lose control of its actions. The main underdeveloped parts of a premature baby are its organs, chiefly the lungs and the brain. The lungs are developed in the last few weeks of pregnancy, and if the child is born before the thirty sixth week, he/she may require some special attention. Usually, the child is monitored closely for the first few weeks of its life, in order to make sure there is no problems with the breathing or any other function of its body. The premature baby will probably need supplemental oxygen to help it through the early stages, but rarely will it need an actual respirator or other life-supporting device on a full- time twenty four hour basis. In fact, giving the baby too much oxygen may complicate problems, such as damages to the eyes. This is caused by a over-abundance of oxygen in the blood stream, which in turn causes the blood vessels of the eye to expand, damaging the eye. This problem is one of the main concerns when bearing a pre-term baby versus a full-term baby. Another difference, probably the most noticeable one, is the size and weight of the baby. A preemie will look thin and helpless, and will also have transparent skin. Blood vessels, veins and bones are sometimes visible through the skin of these babies. This is because the skin of a premature baby is very fragile and tender and can be bruised or broken very easily by a slight amount of pressure. For this reason, many preemies, especially early preemies, are better off not wearing clothing or diapers. Not wearing clothing helps make it easier for the doctor to work with the baby and keep the skin's stress levels to a minimum. Even though the parents may want to hold and cuddle their baby, it is best for the child and the parents if they keep to a minimum the handling of a preemie. Doctors are trying to figure out ways to prevent premature labor from occurring. Through a drug called Ritodrive, doctors have been quite successful in prolonging the pregnancy until the thirty-sixth week(Griesemer 15). Although successful in many cases, doctors are still very skeptical on whether or not women should take any form of drugs while they are pregnant. In the past, there was a belief that the placenta protects the unborn baby from all drugs, bur just recently studies have shown that many drugs can be passed from the mother to the child. Another reason which drugs are not regularly administered to upcoming mothers is that it is very difficult to determine how drugs will actually act on the fetus, since test results can vary so differently from person to person, and also because these results are very unpredictable. For this reason, women are rarely prescribed drugs while pregnant, unless when needed or under the care and supervision of their doctor. Caring for a premature baby can be very tough for parents at times. Since they are urged not to handle the baby much, it makes it very hard for the baby to receive much attention, and also for the parent to see the baby as often as s/he wants to. Feeding a preemie may be a very difficult and cumbersome task. Some preterm babies are fed through an umbilical artery catheter, a tube placed through the navel, or by an intravenous placed through a vein in the baby's head or scalp. This IV contains a solution with the nutrients the baby needs for survival. More mature preemies may be fed by formula, or even breast milk. Breast milk is preferred, if the baby has developed good enough sucking skills, another skill developed late in pregnancy, and also if the baby's body is functional enough to tolerate the milk. Some advantages of breast milk over formula are that breast milk can improve growth, provide antibodies against infection, stimulate faster nerve growth, and help regulate heartbeat and breathing patterns through sucking, making the flow of oxygen more even and efficient. Heart problems are another common problem among prematurely born babies. The most common problem is that blood might circulate through the body, but without passage through the lungs. This happens while the baby is in the fetus, and continues until about the thirty-sixth week when the lungs are almost fully functional. Recently, a drug has been developed that can be used as a substitute to the old method of surgery that was used to combat this problem in most cases. The causes for premature birth is generally an underdeveloped placenta. One thing that is known to have an affect on this is cigarette smoke, which lowers the oxygen supply to the placenta. Drinking alcohol in large quantities and smoking marijuana and doing other drugs also increases the risk for having a premature baby. Having preterm babies is not an inherent trait, which is a common rumor, but some conditions which premature babies have later in life, such as diabetes, are inherent. Age is also a factor which has no effect on bearing a premature child. Although older women tend to be less fertile and have a greater chance of bearing a baby with genetic defects, such as having Down's Syndrome, they do not have to worry any more about having a baby born pre-term than a twenty or twenty-five year old woman. Although this is true, a mother who delivers one preterm baby is more likely to deliver another during her next pregnancy than a mother who hasn't had a problem with previous pregnancy. Another high risk for premature pregnancy is when twins, or other multiple babies, are born. This occurs often because the mother's body cannot hold more than one child for the normal full-term of thirty eight to forty two weeks, and must get rid of the children from the uterus in order to return the body to normal and prevent any injuries from occurring inside the mother's womb. Many advances are occurring everyday which enable mothers to feel safer with the care of premature babies. New drugs are being developed and new methods are being tested to ensure the security of a preemie, enabling the rate of deaths and the rate of premature babies born to both be lowered. As recently as 1986, premature babies had a much lower chance of survival, and with the help of experts, this factor has been greatly reduced. Hopefully, by the time our generation or our children's generation begins to think about bearing children, there will not be much of a risk of having a premature baby. Works Cited Freeman, Roger, and Pescar, Susan. "Safe Delivery: Protecting Your Baby During High- Risk Pregnancy. New York: Facts on File, Inc., 1982. Golant, Susan and Ludington, Susan. Kangaroo Care The Best You Can Do To Help Your Preterm Infant. New York: Bantam Books, 1993. Griesemer, Bernard and Pfister, Fred. The Littlest Baby. Englewood Cliffs: Prentice- Hall Inc., 1983. f:\12000 essays\health & humanities (196)\Prenatel Dianosis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Prenatal Diagnosis: Heredity Disorders, Other Biochemical Diseases, and Disfiguring Birth Defects There are over 250 recognized sex-linked diseases, affecting every organ system. Of these, 95% affect males, (Emery, 1968). Despite these many sex-linked diseases, at present prenatal diagnosis can specifically be made in fewer than 40 diseases. (Emery, 1968). These sex-linked diseases are individual rare and some are named after physicians who described them, for example, Hemophilia A and B, Duchenne muscular dystrophy, fragile-X syndrome, Fabry disease, Hunter syndrome, Lesch-Nyhan syndrome, and Menkes steely-hair syndrome. The following discourse considers the reasons for the importance of prenatal diagnosis, heredity disorders, and disfiguring birth defects.(Nora,1989). Fabry disease is a biochemical disorder caused by a missing enzyme. (Mulinsky, 1989). A complex fatty substance accumulates in the body because of the missing enzyme which would ordinarily break this compound into pieces.(Nora,1989). This missing enzyme causes kidney and blood-vessel problems that lead to high blood pressure, kidney failure and strokes.(Mulinsky, 1989). After many years of symptoms, most patients have died in their thirties and forties owing to a lack specific treatment. A biochemical disorder also caused by a missing enzyme is the Lesch-Nyhan syndrome, an extremely unpleasant disorder characterized not only by profound mental retardation and features of brain damage (stiff limbs with peculiar movements), but also self-mutilation, (Jones, 1988). Given good care and attention however, these patients may live on many years in their profoundly retarded state. They often require restraining, tying their hands, to prevent them from mutilating themselves. Another Affected children with Menkes steely-hair syndrome have hair that feels similar to steel wool; in addition, they are retarded. The basic defect in this condition concerns the way the body handles copper. Only a few of these sex-linked disorders can now be diagnosed in the fetus, (Stein, 1994). At the present time, the only recourse parents have in the case of sex- linked diseases that are not prenatally diagnosable is to determine the sex of the fetus. If a female fetus is found, the parents can be reassured that their child will not be affected (a critical exception is fragile-X). However, if it is determined that there is a male fetus present, there is a fifty percent chance that it is affected, (Milunsky, 1989). Since there is no way of being certain, the parents must decide simply on the basis of high risk weather to take a chance or terminate that pregnancy. There are some unusual sex-linked diseases that are confined to females. Disorders of this kind (such as incontinentia pigmenti, a skin disorder associated with brain damage) can be managed by determining weather the fetus is a female. In this group, virtually all females will be affected, and the parents could selective elect to have unaffected boys. Hemophilia A and Duchenne muscular dystrophy are two of the most common sex-linked diseases that are familiar to most people. But there are so many other diseases that great care must be taken by both the doctor and the family in obtaining an accurate family history. Renpenning syndrome, in which there is mental retardation without any other physical signs, is confined to males. The only way to suspect sex-linked inheritance is for the physician to carefully analyze the family lineage. Tests are preformed to detect female carriers of such diseases. For example, almost all carriers of hemophilia and Duchenne muscular dystrophy can now be detected. A muscle enzyme, creatine phosphokinase, which leaks into the blood is also often measured to give a higher probability of recognizing a carrier. Unfortunately, because of recombination, the carrier-detection tests for both hemophilia and muscular dystrophy do not provide answers in 100 percent of cases. A negative result causes uncertainty and leaves the question of carrier detection basically unanswered. Fortunately, carrier-detection tests are steadily becoming possible in more of the sex-linked and other disorders. Prenatal Studies for Heredity Biochemical Disorders Many hundreds of different hereditary biochemical disorders of metabolism are known. About 1 in every 100 children born have one of these biochemical disorders. (Nora, 1989). Many of these disorders do not cause mental retardation, or impair the child's normal development or general health to any great extent, if at all. Many others, however, cause severe mental retardation, seizures, stunting of growth, and early death. Close to 150 of these biochemical disorders can now be diagnosed in the affected fetus early in pregnancy. (Nora,1989). The first diagnosis of a biochemical disorder in the fetus while in the womb was made in the late 1960's; the disorder was Tay-Sachs disease. (Emery, 1968). Diagnosis such as this are made by obtaining cells from the amniotic fluid which are placed in small dishes containing a nutrient broth, and then kept in a special warm, moist incubator. They grow slowly. After a period of two to three weeks or, occasionally, as long as six weeks, there are enough cells to work on. Each of the cells having the genetic blueprint will show the specific biochemical defect ( for example, deficient activity of an enzyme) thereby enabling a diagnoses to be made. With diagnosis, physicians can treat the known disorder through the womb. For a few disorders, such as Rh disease, treatment of the fetus directly or through the mother has now succeeded. The first prenatal diagnosis of a biochemical disorder that was treatable in the womb was the rare disorder methylmalonic aciduria.(Milunsky, 1989). This disorder causes failure to thrive, vomiting, lethargy, biochemical disturbances, poor muscle tone, and eventually mental and motor retardation. Treatment of the fetus through the mother during pregnancy is carried out by giving her intramuscular injections of massive doses of vitamin B12. This method secures the child's health at birth, when a special low-protein diet is started. In this way serious illness, mental retardation and early death have been averted. Another considerably more common disorder is congenital adrenal hyperplasia (CAH). This heredity disorder is inherited equally through a gene from both parents (autosomal recessive). About 1 in 5,000 to 13,000 whites and 1 in 7550 Japanese are born with CAH - nowhere near the remarkable 1 in 282 among the Yupik Eskimos. (Jones, 1988). Various forms of this disorder occur, each due to a deficient, though different enzyme along a stepwise pathway that finally results in the production of "cortisone". Symptoms of the most common form of CAH are masculinization of the female genitals, excessive growth, early appearance of pubic hair, and enlargement of the penis or clitoris. Critically important in about two-thirds of affected children is the occurrence of a life-threatening crisis one to four weeks after birth, characterized by vomiting, diarrhea, and salt loss leading to collapse and even death if not diagnosed and treated with "cortisone". Where needed, surgical correction of the female genitals is possible, and normal growth, puberty and fertility can be achieved through lifelong medical treatment with cortisone like supplements. Today, both carrier detection and prenatal diagnosis are possible for most families, using DNA techniques combined with special blood-group linkage studies. The very first inherited biochemical disorder found to cause mental retardation was phenylketonuria.(Koiata, 1995). Since that description in 1934, it has been learned that PKU (phenylketonuria) occurs in about 1 in 14,000 newborns in the United States and as frequently as 1 in 4,500 in Northern Ireland.( Nora, 1989). Transmitted by a recessive gene from each parent, all problems are the result of a deficient liver enzyme. An affected untreated child will develop irreversible mental retardation. Therefore, in most Western countries , blood screening of newborns is done to make an immediate diagnosis and institute the special low-protein diet through which mental retardation can be avoided. Despite the availability of effective treatment after birth, prenatal diagnosis remains a serious option for parents. This option is valuable because the special low protein diet is tasteless and very restrictive.(Mulinsky, 1989). Enforcing the diet in early childhood is difficult, and needs to be continued for as long as possible. (Mulinsky, 1989). The usual practice has been to discontinue the diet at four to seven years of age. Recent studies show intellectual deterioration, loss of IQ pionts, learning difficulties, and behavior problems after the diet has been discontinued. (Jones, 1988). A steadily increasing number of women with PKU are entering the childbearing years. (Jones, 1988). If they become pregnant, the chemical products that accumulate in their blood damage the fetal brain and other developing organs. Their risk of having a retarded child or one with a heart defect or microcephaly approaches an incredible 100 percent. (Koiata, 1995). Only a mere handful of cases are known in which the diet was adhered to strictly before conception and a healthy child is born. Today, new DNA techniques have made both carrier detection and prenatal diagnosis of PKU possible for most families and therefore an important decision.(Koiata, 1995). Galactosemia is another treatable hereditary biochemical disease where prenatal diagnosis is possible. If the fetus is affected, special lactose-free dietary treatment of the mother started early enough will almost always avert early death or mental retardation, cataracts, and liver damage.(Jones, 1988). There are a few other very rare disorders where prenatal diagnosis and early treatment may be critical to save life or prevent mental retardation or other consequences. Some of these diseases are: tyrosinemia, homocystinuria, maple-sirup urine disease, and propionicacidemia. (Jones, 1988). A few other disorders are now being conquered by early diagnosis and treatment in the womb. (Jones, 1988). Continued support for medical research will undoubted provide more and more opportunities for early treatment or prevention, reducing the need for abortion, which is a major option and issue today. Progress in actual prenatal treatment for genetic disorders can be anticipated, provided that fetal research is not interdicted by state legislation. (Nora, 1989). The fact that mental retardation is more common in males has been a known fact for about a century. (Emery, 1968). The major reason for this excess became clear in the mid-1970's, when studies from Australia focused attention on an unexpectedly common disorder with striking features: the fragile -X syndrome. (Nora, 1989). This disorder, caused by a single defective gene on the X chromosome, has highly variable signs that usually include mental retardation and distinctive facial features. (Milunsky, 1989). Special studies have revealed the location of the defective gene on the X chromosome: a vulnerable spot that tends to break, hence, the term "fragile-X syndrome." (Milunsky, 1989). Because of the remarkable variability of the physical, behavioral, and developmental features of fragile-X syndrome and the delayed appearance of some major features, definitive recognition of this disorder eluded researchers for many years. (Milunsky, 1989). Confusion was also generated by the fact that although males were primarily affected, within the same families mildly affected females were also observed. It is now known that about 1 in 1,060 males are born with fragile-X syndrome, and that the disorder accounts for about 25 percent of all male cases of mental retardation and about 10 percent of mild to moderate mental retardation in females.(Nora,1989). The main signs of this disorder are on Table 1. Transmission of the fragile-X disorder was initially thought to conform to other sex-linked disorders. Quite unexpectedly, a unique pattern that does not conform exactly to sex-linked inheritance has been discovered only recently. The current knowledge, as studied by Dr. Milunsky, allows certain risk predictions: 1. An intellectually normal female who inherits the fragile-X gene from her carrier mother has a 50 percent risk of having an affected son, whose risk of being retarded is 40 percent . Half her daughters will carry the gene, but only 16 percent will be retarded. 2. If such a daughter is retarded, her risk of having an affected and retarded son is 50 percent. If she has a daughter herself, the risk is 28 percent that the will also be mentally impaired. 3. Men who are seemingly entirely normal and do not even show the fragile-X chromosome when tested may nevertheless transmit the gene to all their daughters. These females are usually intellectually normal. However, when they reproduce, 50 percent of their sons will be affected, and 40 percent will be retarded. Half their daughters will be carriers, among 16 percent will be retarded. 4. Normal-but-transmitting males may account for 20 percent of all cases of the fragile-X syndrome. Unfortunately, they will remain undetectable until new technology revels their ominous burden or until one of their children or grandchildren is diagnosed as having this fateful flaw. 5. Curiously, women carriers who bear a son who is a normal-but- transmitting male have a 50 percent risk of having an affected male, who has only a 9 percent risk of being retarded. This carrier female also has a 50 percent risk of having carrier daughters, and these girls have only a 5 percent risk of being intellectually impaired. Further research inth this devistating disorder and it's complex heridaty pattern may significantly reduce the amount of congenital mental retardation. Heredity, biochemical and other disfiguring birth defects must be a top priority with expectant parents. A knowledge of these concerns will alolow them to make wise decisions regarding prenatal diagnosis and decisions and availability of treatment to prevent birth defects, thereby saving lives. f:\12000 essays\health & humanities (196)\Protecting Dad From the Bad News.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ DESCRIPTION OF THE CASE: Ralph is a recent widower in his midi-60's, who was diagnosed with metatastasized colon cancer. He is a home health agency patient, and his primary caregivers a re his two daughters. Ralph is unaware of the severity of his condition and wanted to know what his state of health and prognosis were. The nurse evaded his questions initially, and his daughters did not want to tell him that his cancer was terminal. The nurse's position was not to continue providing care for Ralph, as she would be deceiving him by not telling him the truth. When the nurse consulted with Ralph's physician, he agreed with the family's decision, as he felt that they needed time to accept their mother's recent death and Ralph's impending death. The doctor ordered the nurse not to oppose him and not to disclose any further infomation to Ralph. THE PRINCIPLE: TRUTH-TELLING & DECEPTION (Should be "FIDELITY") In most cases, a rational person has a right to truthful information and avoidance of deception, which will allow him to decide which course of treatment to follow. A patient's right to decide includes the right to know the truth, not be brainwashed, and not be lied to or deceived by having information withheld that is relevant to his own health. There is a moral standard that condemns lies, deception and withholding of relevant information. To tell Ralph that "everything was all right and he would be up and around the house in no time at all" is deceptive, as his condition is terminal, although he does not yet realize it. The ANA Standards of Clinical Nursing Practice states that clients should be educated about ther illness, which is subsumed within Standards of Care (p3). In Standard V-Ethics (p15), measurement criteria #3 states that "the nurse acts as a client advocate" and #5 states the "nurse delivers care in a manner that preserves and protects client autonomy, dignity and rights". The "Patient's Bill of Rights" cites somes cases that justify overriding a patient's autonomy rights, however. Considering that Ralph has recently lost his wife and that he is still working through his own grief may present a morally compelling reason for withholding information and considering Ralph's best interests. His emotional status may need to be assessed to assure that he would not be suicidal or lose interest in the remaining quality of his life, also to determine his ability to cope, before telling him the truth, and prevention of harm overrides autonomy rights. If I were involved in Ralph's care as his nurse, I would have great difficulty with deceiving or withhold information from him, but considering the impact of his wife's death, combined with the knowledge of his own inevitable demise, I would take into consideration his emotional state first, as his advocate, and work with his daughters in establishing a set time to inform him of his condition, assuming that he has at least a few months to live. This will hopefully allow the daughters more time to accept their mother's death and their father's condition. We would have to agree not to lie to Ralph outright, but to encourage him to participate in his own care as much as possible, as well as perform his own ADL's as tolerated. By so doing, Ralph would be able to maintain his dignity, his daughters would be placated, and a lawsuit hopefully avoided. References: American Nurses Assoc (1991). Standards of clinical nursing practice. american Nurses Publishing. Washington, DC. Bandman, E. & Bandman, B. (1995). Nursing ethics through the life span. appleton & Lange. Norwalk, CT. f:\12000 essays\health & humanities (196)\ProzacMania.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Prozac-Mania ³Yeah, I'm on Prozac,² I hear quite often, said as if the speaker had just received a new Porsche. I often do catch myself responding with, ³I'm on Zoloft‹isn't modern medicine great?² In a way, this exchange is a way of bonding. In another, more twisted way, it is a way of receiving a stamp of approval from my peers, for antidepressants have become extremely widespread and widely accepted. ³Prozac...has entered pop culture...becoming the stuff of cartoons and stand-up comedy routines² ‹and, of course, really bad jokes by people who do not take the drug. (Chisholm and Nichols 36). These days, being prescribed an antidepressant carries less stigma than in the past. ³Prozac has attained the familiarity of Kleenex and the social status of spring water² (Cowley 41). Gone are the days when the label ³loony² is slapped upon a person taking these drugs. Antidepressants have become almost as commonplace as Tylenol. Prozac is being prescribed for much more than clinical depression. Some of the other illnesses that are treatable by Prozac include bulimia, obsessive-compulsive disorder, and dysthymia, which is chronic low-grade depression. In some cases, it is even prescribed for anxiety or low self-esteem (Chisholm and Nichols 38). Part of the popularity of Prozac stems from declining health care. ³As medical plans cut back on coverage for psychotherapy, says [Dr. Robert] Birnbaum of Boston's Beth Israel, psychiatrists feel pressure simply to Œmedicate and then monitor side effects¹² (Cowley 42). General practitioners, however, write the majority of Prozac prescriptions. Both of these scenarios raise concerns, as some psychiatrists state that it can be dangerous for antidepressants to be used without concurrent psychotherapy sessions (Chisholm and Nichols 38). When I discontinued my therapy sessions after two years, yet still continued to take my antidepressants, I felt as if something was missing from my life. Therapy has been a very important part of my treatment, and I would not have recovered as well if I had not attended regular psychotherapy sessions. With the common use of Prozac and other antidepressants, another consideration arises: are these drugs becoming a substitute for really coping with problems? Prozac and the related antidepressants, such as Paxil and Zoloft, are known as selective serotonin re-uptake inhibitors (SSRIs). They prevent brain cells from re-absorbing used serotonin, which can elevate the moods and thoughts of people suffering from depression (37). But ³no disease can be blamed solely on a serotonin imbalance² (Watson 86). External factors and genetics often affect depression. As a two-year recipient of Zoloft, I discovered that, during the course of my treatment, my interludes of depression would return at stressful times, despite the medication. Mental illness also runs in my family. On my father¹s side of the family, my great-grandmother suffered from dementia, and on the maternal branch of the family tree, my mother shows signs of dysthymia. This, of course, does not mean that clinical depression is not caused by a serotonin imbalance. The truth is, researchers are still looking for the causes of emotional illnesses in order to design more specific solutions (86). In the meantime, many people are receiving Prozac and related medications for trivial personality disorders, and a stigma remains firmly attached to people with genuine mental illness. ³Mental illness is still often thought of as something you or your parents did wrong,² which is another reason why many patients are simply taking the medication instead of also seeing a therapist (Marrou). I will readily admit that I am on Zoloft, but I usually keep my ³shrink² appointments a secret from all but my closest friends. Of course, the pop culture references only serve to heighten the overall contempt toward younger people on antidepressants, and the glamour of taking them. In the recent Kids in the Hall movie, ³we [were] offered a wacky dystopian vision of a world Prozaced out of its wits² (Ansen). This refers to the wide usage of antidepressants to treat trivial disorders. ³Happy pills for every occasion² ‹doctors are still looking for the perfect way to treat minor personality disorders (Chisholm and Nichols 40). It seems that taking Prozac is ³cool,² especially among young people, who can prove that they, too, are angst-ridden and rich enough to take these seemingly designer drugs. Yet, where would Sylvia Plath be if she had taken an antidepressant? True, she would be alive, but her work would not have been so introspective or moving. She would also have been easily forgettable. Prozac is said to reduce insight and emotions (Cowley 42). As a recipient of Zoloft, I can attest to that statement. My moods have been dulled. I once possessed a great deal of emotions, and now only feel two: ³bummed out² (slightly depressed and highly irritable) and hyperactive. I have also noticed that my poetry is not as moving as it was when I was medication-free. Lately, I have thought of discontinuing my medication. The social stigma does irritate me; after the first five Prozac jokes, I stopped laughing. That is not my reason for desiring an end to the medication, however. I want to quit because I do not feel like, well, me. I do not cry or laugh normally; it all seems as if I am watching someone else cry or laugh for me. Technically, I am not even clinically depressed. I have been diagnosed with dysthymia, a mild yet chronic form of depression, which I know was caused by extreme stress several years ago. I continue to experience a great deal of stress in my life, but I would like to learn how to cope with it instead of merely popping a little yellow pill. What happens if I lose my health insurance? I would not be able to afford medication, and would have to learn anyway. As it is, my most recent therapist decided that I no longer need psychotherapy, so why am I still taking this medication? It has become a crutch for me. I agree with Kurt Cobain when he sings, ³I¹m so happy/ Œcause today I¹ve found my friends/ in my head.² My own emotions are always better than drug-induced feelings. Even the lyrics by Cobain prove just how mainstream antidepressants have become, even though Cobain sings about Lithium, which is used to treat manic-depressive patients. An entire computer bulletin board is devoted to Prozac alone, and endless resources exist on the World Wide Web (Cowley 41). As we joke about Prozac and recommend it to our friends, though, it is becoming too widespread to be ignored. In ten years, we might all be taking some form of medication to stabilize our moods and ³fine-tune the behavior of a given person. We may be able to almost modulate personality² (Chisholm and Nichols 40). There is something truly creepy about an entire nation walking around with what my friend Joy calls ³perma-smiles,² the alleged happiness found in antidepressants. Is it even ethical to create a society where nobody feels their own emotions? ³The ultimate question, assuming that the new antidepressants can safely banish unpleasant feelings, is whether we really want to be rid of them² (Cowley 42). And do we all want to be happy all the time? If you cease to feel pain, then your happiness seems dulled. More alarming is the amount of people I know that have been on some antidepressant or another by the age of eighteen. It seems that normal teenage mood swings are being diagnosed as depression, and medication is readily prescribed. While some experts say that ³treatable psychiatric problems are far more common than most people realize,² why has medication become so popular as a treatment? (42). Another friend of mine likes to cling to the ³conspiracy² theory: the medication is being used to lull us into complacency. I sometimes wonder about this myself. Annually, Prozac¹s worldwide sales reach nearly $1.2 billion (41). Millions of people take some form of an antidepressant (Marrou). It is sick, in a way. Still, doctors and patients alike have nothing but praise for these drugs that make treating a debilitating illness so much easier (Chisholm and Nichols 36). The side effects are fewer than the older antidepressants, and they do not last that long. I experienced only three days of nausea, gastrointestinal problems, and a dry mouth when I first started taking Zoloft. Now I experience no side effects. The absence of these side effects seems to contribute to the popularity of the drugs. After all, who would want to take a pill that makes them sick, especially if the person is only experiencing anxiety or slight depression? This all contributes to the entire culture behind Prozac and other antidepressants. The culture that I have observed extends from successful students to clove-smoking, sour-faced poets sitting in offbeat coffeehouses. Antidepressants have become drugs for everyone, the ³feel-good² drugs of the nineties, it seems. Yet the liberal usage of Prozac raises another, more important concern. Prozac may have many unforeseen consequences, and is being compared to Valium, which was on the market for ten years before doctors discovered just how addictive it was in the mid-1970s. Some say that Prozac has become the Valium of the nineties (38). Since its release in 1988 by Eli Lilly and Co. of Indianapolis, it has been prescribed to numerous patients. But what side effects and dangers will we discover in the future? Ostensibly, individuals taking Prozac are guinea pigs. The glamour of antidepressants fades when factors such as possible side or after-effects, dulled emotions, and the necessity of therapy is taken into consideration. However, the use of Prozac will continue just as strongly as ever. Doctors will continue to medicate patients for as long as health plans cut back psychotherapy benefits. The pop culture references will remain firmly in place as more people begin to take Prozac, including the unfunny jokes. And where will we be in ten years? Hopefully, we will not be diagnosed with cancer or some other antidepressant-induced illness. For some reason, I doubt we will be joking about that as liberally as we do our antidepressants. Works Cited Ansen, David. ³Kids in the Hall Send Up Our Prozac Culture.² Newsweek: America Online (keyword: newsweek) 22 April 1996. Chisholm, Patricia and Nichols, Mark. ³Questioning Prozac.² Maclean¹s 23 May 1994: 36-40. Cobain, Kurt. ³Lithium.² Nevermind. Nirvana. Virgin Songs, Inc. and The David Geffen Company, Track 5, 1991. Cowley, Geoffrey. ³The Culture of Prozac.² Newsweek: America Online (keyword: newsweek) 7 February 1994: 41-42. Marrou, Chris. ³I hope that one day mental illness will be as openly accepted as any physical disability.² Newsweek Online 24 June 1996. Watson, Traci. ³Ode to a mellifluous brain molecule.² U.S. News & World Report 25 November 1996: 86. f:\12000 essays\health & humanities (196)\Quackery.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ This year, we Americans will spend billions of dollars on products that do nothing for us - or may even harm us. And we'll do it for the same reason people have done it since ancient times... We want to believe in miracles. We want to find simple solutions and shortcuts to better health. It's hard to resist. All of us, at one time or another, have seen or heard about a product - a new and exotic pill, a device, or potion - that can easily solve our most vexing problem. With this product, we're told, we can eat all we want and still lose weight. We can grow taller or have bigger breasts. Or we can overcome baldness, age, arthritis, even cancer. It sounds too good to be true - and it is. But we're tempted to try the product in spite of all we know about modern medical science - or perhaps because of it. After all, many treatments we take for granted today were once considered miracles. How can we tell the difference? Not all advertisements for health products are false, of course. In fact, the vast majority aren't .So just what is quackery? Simply put, quackery is the promotion of a medical remedy that doesn't work or hasn't been proven to work. In modern times, quackery is known as health fraud. But call it quackery or call it health fraud, the result is the same - unfulfilled wishes, wasted dollars, endangered health. Often quack products are fairly easy to spot, like the magic pills you are supposed to take to stay forever young. But sometimes the products are vaguely based on some medical report that you may even have heard about in the news. In general, when looking over ads for medicines and medical devices, watch out for those that seem to promise too much too easily. Quack cures rob us of more than money. They can steal health away or even take lives. Quacks may lure the seriously and often desperately ill, such as people suffering from arthritis and cancer, into buying a bogus cure. When people try quack remedies instead of getting effective medical help, their illnesses progress, sometimes beyond the treatable stage. Quacks have always been quick to exploit current thinking. The snake-oil salesmen a few generations back carried an array of "natural" remedies to sell to a public that was still close to the frontier. And today, quacks take advantage of the back-to-nature movement, capitalizing on the notion that there ought to be simple, natural solutions to almost any problem. Some current target areas for such promotions include: ARTHRITIS. Over 30 million Americans suffer from arthritis, and the nature of the disease makes it fertile ground for fraud. And because symptoms may come and go, or the disease may be in remission for several years, arthritis sufferers may actually believe at least temporarily, that they've been cured by a quack remedy. Before you add to the $2 billion spent annually on quack arthritis cures, remember that, although medical science offers effective treatments, it has found no cure for arthritis. The list of fraudulent "miracle cures" for the disease ranges from snake venom to lemon juice, from the harmless milk of vaccinated cows to the dangerous use of steroids. More dangerous and costly arthritis treatments are offered by legitimate-looking clinics, often located outside the United States. While some clinics may offer effective treatment, many prescribe untested diets or drugs that either offer no arthritis cure or cause patients to have additional health problems. Beware of arthritis clinics that offer cures. It is important to remember that pain relief and inflammation treatments are not the same. A product that advertises relief for the minor pains of arthritis does not necessarily treat inflammation. For this reason, the serious condition of arthritis should be treated by a doctor. CANCER. Here quack cures are probably the cruelest and the most expensive. Seriously ill people may spend thousands of dollars on phony treatments that do nothing to relieve their disease or suffering. Often, the quack cancer treatment clinics are set up just outside the United States, so that they're beyond the jurisdiction of U.S. authorities. Before you request admission to any cancer clinic, talk to your doctor about it. As an aid in evaluating cancer-cure claims, keep in mind that there is no one device or remedy capable of diagnosing or treating all types of cancer. Cancer cannot be detected or treated solely through the use of machines. No one medical test conducted one time can definitively diagnose cancer, nor can a machine operated by a fraudulent practitioner cure it. Teens are also a big target of quackery. Teenagers are ready to experiment with products that promise to speed their development and ease growing pains. And many of these junior and senior high school age children have money enough to do the experimenting. In fact, a study by Teenage Research Unlimited revealed that 27.6 million teenagers spent an average of $93 a month on personal items in 1989 for a total of nearly $31 billion. Further, in families in which both parents work, teens take on more of the family shopping responsibilities. The U.S. Labor Department reports that as of March 1988, %62.4 of families with teenagers had two working parents. And a 1987 report by Teen Research Unlimited showed that teens do the shopping in %70 of the households with working mothers. Many people believe that advertising is screened by a government agency and that, therefore, all claims about health products in advertising must be truthful. This is not the case with most health-care products, except for those drugs and medical devices that require pre-market approval by FDA. There is no federal, state, or local government agency that approves or verifies claims in advertisements before they are printed. Law enforcement authorities can take action only after the advertisements have appeared. This holds for claims of a "money-back guarantee." Many quacks are fly-by-night operators who do not respond to refund demands. Often, by the time refund requests come in, they have changed their address to avoid law enforcement officials. Health fraud promoters are fond of using testimonials from "satisfied users" to promote their wares. One reason they do this is that they can't get ethical health professionals to sanction their products. Legitimate testimonials may be useful sources of information about how a product works. However, beware of testimonials reporting incredibly fantastic medical results, especially when no medical support for the claim is offered. This is particularly important since "satisfied users" may, in some cases, have experienced the sugar pill, or "placebo" effect. The placebo effect occurs when people, believing they have been given a real medicine, experience a benefit from it. It is the power of suggestion at work. There are many ways to protect yourself from quackery. Apply the "it-sounds-too-good-to-be-true" test to ads for health products by watching for these common characteristics of quackery: A quick and painless cure. A "special," "secret," "ancient," or "foreign" formula, available only through the mail and only from one supplier. Testimonials or case histories from satisfied users as the only proof that the product works. A single product effective for a wide variety of ailments. A scientific "breakthrough" or "miracle cure" that has been held back or overlooked by the medical community. To sum everything up I think that quackery is costing Americans too much money every year and needs to be stopped. Tighter government regulations and stricter rules from the FDA will help. f:\12000 essays\health & humanities (196)\Reye Syndrome.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Reye Syndrome is an extremely rare, non-contagious disease thought to be triggered by aspirin use. The actual origin of the disease is unknown. Reye's Syndrome, occasionally called Reye-Jacobsen's Syndrome, is known to follow any viral infection. Two of the most common viral infections it precedes is influenza, "the flu", and chicken pox. A now-familiar warning on bottles of aspirin, most notably Tylenol, is not to give Tylenol to a child who is recovering from the chicken pox, a fever, or any other viral infection. The link between aspirin and Reye's Syndrome and is not fully understood, but all reported cases of Reye's Syndrome include a child who has received aspirin before infection. Symptoms of Reye's Syndrome may often be mistook for a recurrence of the flu, or extreme exhaustion. These symptoms include vomiting, confusion, lack of coordination, distorted balance, irritability, a stupor-like state, and a recent infection from a viral illness. The symptoms often begin with vomiting and progress to a stupor and near comatose state. This disease is often found in young children and infants. Over sixty percent of reported Reye's Syndrome cases occur in children under the age of sixteen, with the majority of these cases being in children under six. Although less than five percent of Reye's Syndrome cases occur in people over the age of sixty, the elderly are often the most severely affected, due to old age and weakening immune systems. Infants, while hindered by their young age, can often fight the infections of Reye Syndrome better, for reasons doctors do not yet fully understand. The severity of Reye's Syndrome is classified on a scale of 1-5, with one and two being the onset of symptoms and four and five being the most severe, with the patient being comatose. With the most severe of Reye's Syndrome cases, internal fluid builds up in the brain and there is irreversible brain damage or even death. While the disease is not often fatal, it is essential to treat the disease early. Reye's Syndrome is not contagious, but the diseases that can lead to, such as the flu, and chicken pox, are highly communicable. The first case of Reye's Syndrome was diagnosed in 1963. Looking back into medical journals, there were many "mystery illnesses" that had the same symptoms as Reye's Syndrome, but no cases were positively diagnosed as being Reye Syndrome until this date. The definitive tests for this disease are a liver biopsy and blood analysis. The liver biopsy can help determine the presence of fat and lipid formation in the liver. Upon surgical examination, the liver is slightly enlarged, firm, and bright yellow. This includes some of the symptoms of jaundice, but without the yellowing of the skin and pupils of the eye. There is often bile build-up within the liver, and fat formation on the liver walls is always present. The blood test can detect the presence of ammonia and acid within the blood. The failing liver will produce these chemicals. There is also a dramatic decrease in blood sugar levels, which can mistakenly be diagnosed as hypoglycemia. Therefore, a liver biopsy is essential in making a complete and correct diagnosis of Reye's Syndrome. The treatment for Reye's Syndrome had made great advancements in the last decade. Through the 1960's and the 1970's, the fatality rate for victims of Reye's Syndrome was over forty percent. In the 1990's, this fatality rate has decreased to less than ten percent. Part of this decrease is due to a greater elevation of public awareness. Doctors are able to give more complete information to their patients. Parents who have children recovering from the flu and chicken pox are warned never to give aspirin for fever and pain. Another reason for the decrease in fatalities is due to increasingly better understanding of the disease. Before the first diagnosis in 1963, patients who could have had Reye's Syndrome were treated with medication for intestinal and stomach flu, or given anti-nausea drugs and aspirin(obviously, a big no-no) and sent home with instructions to call the doctor if it got any worse. Many of these "treatments" ended in death for the patient. Treatment of the patient now includes cortosteroids to treat brain swelling. This has greatly helped reduce the occurrence of moderate to severe brain damage in patients with Reye Syndrome. All treatment is given intravenously, which can help to stabilize the blood chemistry. Stabilizing this is extremely important to the survival of the patient because of the high levels of ammonia and acid within the body that circulate through the blood. The treatment given to people with Reye's Syndrome is more passive than active treatment. This includes monitoring the heart rate, giving intravenous fluid to prevent dehydration, and keeping fevers down. Depending upon the severity of the illness, the recovery periods will vary from case to case. The younger a child, the longer the recovery period, which can last anywhere from two weeks to three months. When a patient has contracted Reye's syndrome after having the chicken pox or influenza, as opposed to a common cold or other viral infection, the recovery period is substantially lengthened. New and groundbreaking research for the link between aspirin and Reye's Syndrome is now underway in places such as Johns Hopkins University, the Mayo Clinic, and The California Center for Disease Control, or CCDC. The CCDC has come up with a theory that is becoming more and more widely accepted. A possible link, they claim, is the chemical effects of aspirin on the brain. While reducing fever and pain, aspirin may, they hypothesize, cause the body to release endorphins that can trigger the onset of Reye's Syndrome. Another probable theory has been introduced by scientists at the Mayo Clinic. Aspirin, they theorize, lowers the body's immunity to certain micro-organisms that may cause the beginning of Reye Syndrome. While Reye's Syndrome used to be a misunderstood and often fatal disease, public understanding has greatly increased. The training of doctors and medical assistants has greatly increased, and their knowledge of the disease has greatly increased. Along with this increased public awareness is the breakthrough research mentioned above. Over eighty million dollars was allotted to study Reye's Syndrome in 1993, and that amount has increased greatly since then. As the twentieth century looks towards new developments in medicine and disease control, Reye's Syndrome will hopefully become nothing more than an obsolete disease of the past. f:\12000 essays\health & humanities (196)\rotator cuff.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Central Michigan University baseball is one of the finest in the state of Michigan. Baseball players at C.M.U. are dedicated to being the best on and off the field. I had the privilege of working baseball for my first PES 283 rotation, and I think I will never forget it for the rest of my life. Coach Kriener demands the athletes to be the best students-athletes that they can be. I believe this is one reason no senior has graduated in twenty years without winning a ring. He teaches them to be winners; he will not accept anything but the best. I believe that the best way to avoid injuries is to be in shape and use common sense. There are many factors that could cause injury on a baseball diamond. The best way to make our job as trainers easier is to prevent these injuries. The best way to prevent injury is to make sure that all the equipment is put on the side and not on the middle of the field, where someone going for a foul does not trip over a baseball or a helmet. I do not think athletes really think in such terms until someone actually gets hurt. One thing that I always kept my eye on when I was working was to make sure the catcher's were wearing their face mask when they were warming the pitchers in the bullpen. At first, the athletes thought I was telling them to put their mask on as an authoritative figure; however, after I explained to them it was for their own good, and I was only looking out for their safety, they realized why I was doing it. I believe one way to get the respect of the athletes and coaches on a team is to let them see you care about them, and you as the trainer care about them winning. Warming and cooling down before and after practice is another good way to prevent injury. Warming up by running and then stretching will help prevent injury. Light jogging gets the blood supply flowing and will enhance the stretch. I believe it also gets the athlete ready to perform. Stretching will also promote flexibility, a big factor with being "in shape." The cool down period is also important in making sure the athlete stays in shape aerobically. This will maximize the practice. I always made sure the athletes did all their running before they received their ice. I found out the N.C.A.A. really did not impose a lot of safety factors for baseball. The only thing according to Kevin Smoot the only safety prevention methods the N.C.A.A. mandates are the batter to wear a helmet and the catcher wear a mask and the protective equipment. The big thing that suprized me is the players are not mandated to wear a protective cup. Any player in their right mind would wear one, but sometimes you get one or two athletes that are not too bright. One major thing that I saw and heard pitchers use to help prevent shoulder injury is the offseason shoulder workout program. It has been over twenty years since a pitcher with no previous injury and who has honestly done the workout miss a start in the rotation to shoulder injury. The shoulder program was one of the biggest things that impressed me. I will make sure before I leave C.M.U. I have a copy of the program and make sure my athletes use it. If we as trainers can prevent shoulder injuries we can go a long way as baseball trainers. Shoulder injuries are the biggest problem for throwing athletes. If the shoulder problem does not get taken care of the injury could move down to the elbow and keep move on down and could possibly end a athletes career. I truly enjoyed working with baseball. Baseball was definitely a step up from working with Women's basketball. After leaving baseball I felt as if I was associated with a group of winners that played to win sometimes I wondered about that sometimes working basketball. I worked with fourgoodstudent trainers, three fellow 283's, and a ATC that I learned a lotform. I do not think I could of been any luckier. It was truly a blast. REFERENCES 1. Fleisig, Glen S., PhD "Kinetics of Baseball Pitching with Implications About Injury Mechanisms." The Journal of Sports Medicine. March-April 1995, vol. 23, no.2, pp. 223-239. 2. Arnheim, Daniel., and William E. Prentice, Principles of Athletic Training, 8th ed. Illinois: Chicago, 1993 723-727. 3. Kabban, Elias S. "PES 280 Notebook" Spring 1996. 4. Interview with Kevin Smoot BASEBALL Fall 1996 Elias S. Kabban PES 283 10-17-96 f:\12000 essays\health & humanities (196)\Safe VS Unsafe SEX.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ SAFE SEX vs. UNSAFE SEX The "sexual revolution" of the 1960's has been stopped dead in its tracks by the AIDS epidemic. The danger of contracting AIDS is so real now that it has massively affected the behavior of both gay and straight folks who formerly had elected to lead an active sexual life that included numerous new sexual contacts. The safest option regarding AIDS and sex is total abstinence from all sexual contact. For those who prefer to indulge in sexual contact, this is often far too great a sacrifice. But it IS an option to be considered. For those who wish to have sexual contact with folks on a relatively casual basis, there have been devised rules for "safe sex". These rules are very strict, and will be found quite objectionable by most of us who have previously enjoyed unrestricted sex. But to violate these rules is to risk unusually horrible death. Once one gets used to them the rule for "safe sex" do allow for quite acceptable sexual enjoyment in most cases. Note that even when one is conscientiously following the recommendations for safe sex, accidents can happen. Condoms can break. One may have small cuts or tears in ones skin that one is unaware of. Thus, following rules for "safe sex" does NOT guarantee that one will not get AIDS. It does, however, greatly reduce the chances. There are many examples of sexually active couples where one member has AIDS disease and the other remains seronegative even after many months of safe sex with the diseased person. It is particularly encouraging to note that, due to education programs among San Francisco gay males, the incidence of new cases of AIDS infection among that high risk group has dropped massively. Between practice of safe sex and a significant reduction in the number of casual sexual contacts, the spread of AIDS is being massively slowed in that group. Similar responsible action MUST be taken by straight folks to further slow the spread of AIDS, to give our researchers time to find the means to fight it. Despite a veritable blitz of AIDS information, experts claim that too few are changing their lifestyles or behavior sufficiently to protect themselves from AIDS and other sexually transmitted diseases. A recent Canadian poll revealed widespread ignorance of the fact that AIDS is primarily a sexually acquired infection, not caught by touch. The survey showed that although sexual intercourse has risen steeply in the past 10 years, less than 25 percent of adults aged 18 to 34 have altered their sexual behavior to protect themselves against AIDS, i.e. by consistent use of condoms and spermicide. THE CENTRAL MESSAGE IS CLEAR: UNLESS ABSOLUTELY SURE THAT YOUR SEX PARTNER IS HIV-FREE, USE A CONDOM (latex, not made of animal material) plus a reliable spermicide. Studies with infected hemophiliacs show that condom use by a regular sex reduces infection risks, compared to unprotected sex. And regular use may bring the added reward of preventing other sexually transmitted-diseases such as gonorrhea and chlamydia or unwanted pregnancy. Many educators say that, by whatever means, AIDS information must get out to young people at an early enough age for them to absorb it before becoming sexually active. The best way to avoid AIDS is to regard it as a highly lethal disease and treat it common sense prevention. Avoiding infection is IN ONE'S OWN HANDS. To halt its spread, people are encouraged to and apply accurate AIDS information to their living styles and sexual partners in order to reduce the risk of getting or transmitting the virus. Health promoters claim that "reaching the many who don't want to know" is no easy task. They suggest that educators must learn how and to communicate AIDS information. Many Public Health Departments are now taking the lead in education about AIDS with large scale public awareness programs. Premarital sex is also bad for your physical health. Sexually transmitted diseases have received abundant attention from the press in recent years. Equal time has not been given to the opinion held by many medical experts that extra-marital abstinence is without a doubt the best way to avoid these diseases. Premarital sex is hardly an expression of freedom. Young people who become sexually active in response to peer pressure to be sophisticated and independent are actually becoming victims of current public opinion. No one is really free who engages in any activity in order to impress the majority. As of now, no other current methods of contraception are considered effective enough to count on. The only sure way to avoid pregnancy is not to have intercourse at all. Put another way, the only 100% effective oral contraceptive is the word "NO!" Since going all the way to intercourse involves such serious risks, how can one deal with all those sexual urges? You have a number of options. 1. ABSTAIN. You can use will power. No one has to have sex. Many go without having sex for years or even a lifetime without negative results. 2. PLAN. Plan ahead and decide how far down the "road to arousal" you think you should go. Go no farther. Express your emotions up to that point, and then just call a halt. 3. SUBLIMATE. You can firmly decide to engage in some other kinds of things as a deliberate substitute for giving in to your sex drive. It could be sports, exercise, art, or some hobby - almost anything that really holds your interest. This can distract your attention away from thoughts of sex. 4. AVOID. Avoid all the kinds of things that can tempt you. Some other very serious STD's besides aids are: Gonorrhea, Syphilis, Genital Warts and Human Papilloma Virus, Genital Herpes, HSV, Crabs, Pubic Lice, Nonspecific Urethritis (NSU) or Nongonoccal Urethritis (NGU), and Hepatitis B. f:\12000 essays\health & humanities (196)\schizophrenia 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ "In my senior year of high school, I began to experience personality changes. I did not realize the significance of the changes at the time, and I think others denied them, but looking back I can see that they were the earliest signs of illness. I became increasingly withdrawn and sullen. I felt alienated and lonely and hated everyone. I felt as if there were a huge gap between me and the rest of the world; everybody seemed so distant from me." This excerpt describes part of Esse Leete 20-year battle with schizophrenia. She committed herself to leading the fullest life her disease will allow and to educating others about mental illness. Schizophrenia is a very serious disease, but through defining schizophrenia and getting the patient help and treatment a schizophrenic can lead a full life like any other person. Schizophrenia is defined as any of a group of psychotic reactions characterized by withdrawal from reality with highly variable affective, behavioral and intellectual disturbances by the American Heritage Dictionary. No definition of schizophrenia can adequately describe all people with this illness. Schizophrenia is an extremely complex mental illness. It is clear that schizophrenia is a disease which makes it difficult for the person with the illness to decide what is real and what is not (Swados 5). It is also clear that this brain disease affects normal, intelligent people in all walks of life. There are six concrete phrases that describe schizophrenia: it is a real disease, has concrete and specific symptoms, is different from other mental illnesses, is the result of flaws brain biochemistry, may be treated by specific antipsychotic drugs, and is almost always treatable. Scientist are unsure of the causes of schizophrenia, although research is progressing rapidly. Scientist are almost certain that schizophrenia has more than one cause. One cause could be a chemical imbalance. An imbalance of the brain's chemical system has long been suspected as the main cause of the illness (Youth 2). A second cause could be stress. Most authorities disagree that severe stress can cause the illness. Stress can however, worsen the symptoms when the illness is already present. A third cause could possibly be genetic predisposition. Genetic transmission has yet to be proven even though schizophrenia tends to run is some families(Youth 3). For example, schizophrenia occurs in 1% of the general population but children with one schizophrenic parent have a 10% chance of developing the illness. When both parents have schizophrenia the percentage of risk rises to approximately 40% (Youth 3). Scientists today think that in some types of schizophrenia, the illness may ride along not only on one common gene, but on various rare genes or a combination of fairly common genes (Youth 3). While the causes are unclear, schizophrenia definitely is: not caused by childhood diseases, poverty, domineering mothers and/or passive fathers, or guilt, failure or misbehavior. Just like an other illness, schizophrenia has signs or symptoms. The symptoms are not identical for each person who has the illness. Approximately one-third of those affected may have only one episode of schizophrenia in his lifetime while another one- third may have recurring or continual episodes but lead relatively normal lives in between. A final one-third have symptoms for a lifetime (Youth 3). Schizophrenia always involves deterioration and changes from a previous level of functioning. Family members and friends often notice that the person is "not the same". The person with schizophrenia has difficulty in separating what is real from what is unreal. As the person becomes more stressed by the demands of day to day living, the person may withdraw and the symptoms become more pronounced (Video). Deterioration is noticeable in ares such as: work or academic achievement , how one relates to others, and personal care and hygiene (Video). Symptoms of schizophrenia are noticed in several different areas. The first area is personality changes. Personality changes are a key to recognizing schizophrenia. At first, the changes may be subtle, minor and go unnoticed (Video). As they worsen they become obvious to family members, friends and co-workers. There is a loss of feeling or emotions, a lack of interest and motivation (Youth 5). A normally outgoing person becomes withdrawn, quiet, moody, or inappropriate. When told a sad story, the person may laugh; a joke may cause him/her to cry; or he/she may be unable to show any emotion at all (Youth 5). Another sign is thought change. Thought changes are one of the most profound changes. These changes in thought are the barrier to clear thinking and normal reasonableness (Youth 6). Thoughts may be slow in forming, or come extra fast or not at all. The person may jump from topic to topic, seem confused or have difficulty reaching easy conclusions. Thinking may be coloured by delusions and false beliefs that resist logical explanations (Youth 6). A person may express strong ideas of persecution, convinced that he is being spied on or plotted against. Others may experience grandiose delusions and feel like Superman, capable of anything and invulnerable to danger (Youth 7). Some may feel a strong religious drive or mission to right the wrongs of the world. Perceptual changes are also another symptom of schizophrenia. Perceptual changes turn the world of the ill person topsy-turvey (Youth 8). The nerves carrying sensory messages to the brain from the eyes, ears, nose, skin and taste buds become confused and the person sees, hears, smells and feels sensations which are not real. These are called hallucinations. Frequently, persons with schizophrenia hear voices in their heads condemning them or giving orders such as "hang yourself"(Youth 9). There is always the danger that the order will be obeyed. These people see things that others do not see such as a door in a wall where no door exists or carpets may appear to be walking. There may be hypersensitivity to sounds tastes and smells. The ring of a telephone may seem to be as loud as a fire alarm bell or a loved one's voice as threatening as a lion's roar. The sense of touch may be distorted. They may feel that things are crawling across their skin, or on other occasions they may feel nothing, not even real pain. The sense of self is also a symptom. This is when one or all five senses are affected, the person may feel out of time, out of space, free floating and bodiless and non-existent as a person. Psychiatrists have attempted to classify schizophrenia into several types. These classifications are based on years of experience and research with symptoms and feelings described by patients and observations made by family members, nurses, doctors and psychiatrists. The first type of schizophrenia is the disorganized type. This type of schizophrenia is commonly referred to as the "hebephrenic" type (Youth 11). It has early symptoms which include poor concentration, moodiness, confusion, and strange ideas. The person's speech is frequently incoherent, difficult to understand, rambling. The person's delusions or false beliefs are not well established. The person shows noemotions or they are inappropriate, i.e. silly, giddy laughter (Youth 11). The second type is the paranoid type. The paranoid type is characterized by delusions and/or hallucinations with persecution, or less commonly an exaggerated sense of self importance (Video). Other features may include anxiety for no apparent reason, anger, argumentativeness, jealousy, and ,occasionally, violence. The third type is the catatonic type. The criteria for the catatonic type is a catatonic stupor (marked decrease in reaction to one's environment) or mutism (no speech). The person may have motionless resistance to all instructions or attempts to be physically moved. The person may maintain a rigid or bizarre posture. Another symptom could also be excited physical activity which seems purposeless and the is not influence by the their environment. Another type is the undifferentiated type. Sometimes the major psychotic symptoms cannot be classified into any category listed, or may match the criteria for more than one type of schizophrenia. In addition, to the undifferentiated type there is the residual type. This category is used when there is at least one recognizable episode of schizophrenia, but no ongoing obvious psychotic symptoms, though less clear signs of the illness continue, such as social withdrawal, eccentric behavior, inappropriate emotions, illogical thinking, etc(Youth 12). A person who is thought to have schizophrenia needs help and needs to have treatment. The first step in getting treatment is taking the initiative. The person with schizophrenia or the family of the patient should ask the family doctor for an assessment when the symptoms of mental illness are suspected. Family members will likely be the first to recognize that it is necessary for the affected person to consult a physician for advice. The family needs to remember that the ill person believes that the hallucinations, delusion or other symptoms are real, and so may resist treatment(Youth 13). The second step of getting treatment is being persistent. It is necessary to find a doctor/psychiatrist who is familiar with schizophrenia. The assessment and treatment of schizophrenia need to involve medical people who are well-qualified. The specialist who is chosen should have an interest in the illness, be competent, and has empathy with the patients. If there is any apprehension about the physician/psychiatrist the family has the right to get a second opinion. Assisting the doctor/psychiatrist is the third step of getting treatment. Since patients with the illness may not volunteer much information during the assessment, the family should speak to the doctor or write a letter. In some cases, it may be necessary to send written information. The information that is supplied will greatly assist the physician to make an accurate assessment and outline a suitable course of action. Presently schizophrenia is not a "curable" disease, but is controllable (Youth 15). The treatment of schizophrenia could possibly be medication. Most patients with schizophrenia must regularly take maintenance medication to keep the illness under control. It is difficult for the doctor/psychiatrist to know which medication will work best for a given individual. Many changes in type of drug and dosage may be required. This period of trial and error can be extremely trying for everyone involved. Some medications have unusual and difficult side effect f:\12000 essays\health & humanities (196)\Schizophrenia 3.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Schizophrenia WHAT IS SCHIZOPHRENIA? What does the term schizophrenia mean? In its most elementary sense, we might say that schizophrenia is a disease, invented by Eugene Bleeder. Eugene Bleeder was one of the most influential psychiatrists of his time. He is best known today for his introduction of the term schizophrenia, previously known as dementia praecox. In actuality, schizophrenia is often used generically and inappropriately as it is often applied to almost any kind of unusual behavior of which the speaker disapproves. Schizophrenia is almost universally viewed as the "classic example of madness" . It is a startling and sometimes frightening experience to unexpectedly come across a person who proclaims himself Jesus Christ, rants gibberish, or sits with his body unmoving as if frozen in time and place. For some people, such an experience is too shocking, too fearsome, too repulsive. They hurry away, trying to dismiss the image of the deranged individual from their minds. No other illness is as disabling and baffling as schizophrenia. Today, in spite of the drugs that have allowed many schizophrenics to live at home or in the community, a significant number of people admitted to mental hospitals are victims of the disease. According to the Encyclopedia Of Health, schizophrenics account for nearly 40% of admissions to state mental hospitals, 30% of psychiatric admissions to Veterans Administration hospitals, and about 20% of admissions to private psychiatric hospitals. Schizophrenia is incurable. Its cause or causes are yet unknown, and it is impossible to predict what course the disease will take. There are many theories about the causes of schizophrenia, its progression, and its eventual outcome. They are currently being explored by researchers around the world. Schizophrenia's most dramatic symptoms are severe and perpetual delusions and hallucinations. A delusion is a false belief or idea that logic and reason show to be "crazy". A hallucination is seeing, hearing , or sensing something that is not there. Both symptoms occur in other mental illnesses, but the content of the schizophrenic delusions is often distinct enough that the experienced psychiatrist or clinical psychologist can readily identify the disorder. Another common characteristic of this disabling disease is the disjointed conversation of its victims. Their discourse often consists of a series of vague statements strung together in an incoherent manner. Listeners are left puzzled by what they have heard and this can be attributed to the unevenness of the schizophrenic's speaking patterns. To one degree or another, schizophrenics display a certain indifference or nonchalance regarding what is happening around them. Their whole emotional outlook is deadened, and they show little or no warmth toward others. They suffer from a mental paralysis. Prolonged immobility and jerky, robot like movements are other common symptoms of the disorder. Typically, schizophrenics withdraw emotionally and even physically from the world and the people around them. They exclude reality and focus on their hallucinations, and the other thoughts locked within them. The bizarre thoughts and behavior of schizophrenics usually begin in late adolescence or early adulthood. The syndrome begins with a gradual deterioration of behavior that may be more noticeable to the patient's friends than to parents, especially in a high-school-aged person. Schizophrenia occurs in equal numbers in males and females, but women, on average, seem to develop the disease four or five years later than men do. Rarely does schizophrenia first appear in either sex after age 40, and almost never after 50. Symptoms may occur suddenly and dramatically, but more often they begin slowly, almost imperceptibly. They grow more prolonged, more obvious, and more disturbing , almost inevitably ending in at least one hospitalization. Five long term studies involving more than 1300 patients have concluded that half or more of the schizophrenics had recovered or showed significant improvement in their illness after two to four decades. No one can predict which patients will suffer an unremitting illness, whose schizophrenia will be episodic, or who will eventually go on to recovery. Yet the findings that some schizophrenics do eventually recover have inspired new hopes. A diagnosis of schizophrenia remains serious and frightening, but at least the schizophrenic's outlook may not be as grim and gloomy as was long believed. f:\12000 essays\health & humanities (196)\Schizophrenia Explained and Treatments.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Jeffrey A. Hurt Professor Leary Abnormal Psychology 203 2 May 1996 Schizophrenia: Explained and Treatments Schizophrenia is a devastating brain disorder affecting people worldwide of all ages, races, and economic levels. It causes personality disintegration and loss of contact with reality (Sinclair). It is the most common psychosis and it is estimated that one percent of the U.S. population will be diagnosed with it over the course of their lives (Torrey 2). Recognition of this disease dates back to the 1800's when Emil Kraepelin concluded after a comprehensive study of thousands of patients that a "state of dementia was supposed to follow precociously or soon after the onset of the illness." Eugene Bleuler, a famous Swiss psychiatrist, coined the term "schizophrenia," referring to what he called the "splitting of the various psychic functions" (Honig 209-211). Having a "split personality" is often incorrectly associated with schizophrenia. Possessing multiple personalities on different occasions is a form of neurosis vice psychosis (Chapman). Symptoms most commonly associated with schizophrenia include delusions, hallucinations, and thought disorder (Torrey 1). Delusions are irrational ideas, routinely absurd and outlandish. A patient may believe that he or she is possessed of great wealth, intellect, importance or power. Sometimes the patient may think he is George Washington or another great historical person (Chapman). Hallucinations are common, particularly auditory, as voices in the third person or commenting upon the patient's thoughts and actions (Arieti). Persons may also hear music or see nonexistent images (Sinclair). Schizophrenic thought disorder is the diminished ability to think clearly and logically (Torrey 2). Many times, schizophrenics invent new words (called neologisms) with unique meanings (Chapman). Often it is apparent by disconnected and meaningless language that renders the person incapable of participating in conversation and contributing to his alienation from his family, friends, and society (Torrey 2). There appears to be three major subtypes of Schizophrenia: paranoid, hebephrenic, and catatonic. Delusions, often of prosecution, are prominent in the paranoid type (Arieti). Hebephrenic schizophrenia is characterized by thought disorder, chaotic language, silliness, and giggling (Eysenck, Arnold, and Meili 961-962). In the catatonic form, the person may sit, stand, or lie in fixed postures or attitudes for weeks or months on end. The person may also have a symptom known as "waxy flexibility" in which the victim will maintain positions of the body in which he is put for long periods of time, even if they are uncomfortable (Arieti). There have been many theories to explain what causes schizophrenia. Heredity, stress, medical illness, and physical injury to the brain are all thought to be factors but research has not yet pinpointed the specific combination of factors that produce the disease (Sinclair). While schizophrenia can affect anyone at any point in life, it is somewhat more common in those persons who are genetically predisposed to the disease (Torrey 3). Studies have shown that approximately 12% of the offspring will be schizophrenic if one parent has the disorder and 50% if both parents have the disorder. This may be due to the fact that the offspring are reared in an environment other than normal. Although statistics from adoption agencies show that these rates are more affected by genes rather than environment (Chapman). Three-quarters of persons with schizophrenia develop the disease between 16 and 25 years of age. Onset is uncommon after age 30, and rare after age 40 (Torrey 3). Psychiatric patients are generally insulted by contentions that their trouble was brought on by bad parenting, childhood trauma, or week character (Willwerth 79). Sigmund Freud has suggested that schizophrenia is developed from a lack of affection in the mother-infant relationship in the first few weeks after birth. Increased levels of the neurotransmitter dopamine in the brain's left hemisphere and lowered glucose levels in the brain's frontal lobes have been coupled to schizophrenic episodes (Chapman). Treatment for schizophrenia includes electroconvulsive treatment (shock therapy), psychosurgery, psychotherapy, and the use of antipsychotic medications (Torrey 5). Shock therapy is the application of electrical current to the brain (Long). In 1937, shock therapy was first introduced and was the popular mode of treatment until the late 1950's (Chapman). It is effective in the most severe catatonic forms of schizophrenia, but its use in other forms is debatable (Eysenck, Arnold, and Meili 964-965). Psychosurgery became common in the 1940's and 1950's but is now in disrepute. Lobotomies, most often removal of the frontal lobes, was the most widespread form of psychosurgery. Scientists have since found that by artificially creating lesions in the area of the frontal lobes, one's personality can seriously be modified (Baruk 196-197). For the most part, society has condemned this form of treatment as inhumane. Psychotherapy achieves the best results when the physician listens carefully to his client's symptoms, diagnosis promptly and accurately, advises the person of the diagnosis, and then prescribes a successful treatment program (Humphrey and Osmond, 189). Psychotherapy can offer understanding, reassurance, and suggestions for handling the emotional problems of the disorder and help to alleviate stressful living situations (Long). The majority of mental health professionals believe that psychotherapy combined with drug therapy produce the best treatment of schizophrenia (Walsh 103-104). Since the late 1950's, schizophrenia has been treated primarily with medications. Most of these drugs block the action of dopamine in the brain (Chapman). These drugs can help a great deal in lessening hallucinations and delusions, and in helping to maintain coherent thoughts. But, they usually have serious side effects that contribute to people not taking their medication, and relapse (Long). Haldol is the most commonly prescribed antipsychotic drug to treat schizophrenia. Abbott Laboratories is presently in the process of testing the safety and efficiency of a new drug, sertindole (Torrey 8). Nearly ten years ago the first studies of clozapine opened up a new line of medical research and it was hailed as a miracle drug. Unfortunately, a small percentage of patients on clozapine develop a blood condition known as agranulocytosis and have to stop taking the medication (Long). Agranulocytosis is a disorder noted by a massive reduction in the number of white blood cells which usually results in the occurance of infected ulcers on the skin and throat, intestinal tract, and other mucous membranes. Agranulocytosis may cause a bacterial infection to become fatal since white blood cells are an important defense against microorganisms (Chapman). A new medication, olanzapine, may be the next miracle drug on the market. Recent studies have shown that olanzapine offers many of the same benefits of clozapine but apparently without the side affects (Torrey 8-9). Hospitalization is often necessary in cases of acute schizophrenia to ensure safety of the affected person, while also allowing initiation of medication under close supervision (Torrey 10-11). In milder cases, family therapy has been to be found helpful. With this type of therapy, family members learn to live with the person in an understanding and accepting manner (Chapman). In the following excerpts from her life story, Esso Leete describes her 20-year battle with schizophrenia and her growing acceptance of her illness. She has committed herself to leading the fullest life her disease will allow and to educating others about mental illness. She's employed full time as a medical records transcriptionist at a hospital where she was once committed (Long). "It has been 20 years since I first became mentally ill. As I approach 40, I find myself still struggling with the same symptoms, still crippled by the same fears and paranoia. I am haunted by an evasive picture of what my life could have been, whom I might have become, what I might have accomplished. My schizophrenia is a sad realization, a painful reality, that I live with every day. Let me tell you a little about my history. I probably inherited a predisposition to mental illness; my uncle was diagnosed as having dementia praecox", an earlier term for schizophrenia. In my senior year of high school, I began to experience personality changes. I did not realize the significance of the changes at the time, and I think others denied them, but looking back I can see that they were the earliest signs of illness. I became increasingly withdrawn and sullen. I felt alienated and lonely and hated everyone. I felt as if there were a huge gap between me and the rest of the world; everybody seemed so distant from me. I reluctantly went of to college, feeling alone and totally unprepared for life away from home. I was isolated and had no close friends. As time went on, I spoke to virtually no one. Increasingly during classes I found myself drawing pictures of Van Gogh and writing poetry. I forgot to eat and began sleeping in my clothes. Performing even the most routine activities, such as taking a shower, rarely even occurred to me. Toward the end of my first semester, I had my first psychotic episode. I did not understand what was happening and was extremely frightened. The experience left me exhausted and confused, and I began hearing voices for the first time. I was admitted to a psychiatric hospital, diagnosed as having schizophrenia, treated with medications and released after a few months. During my late teens and early 20s, when my age demanded that I date and develop social skills, my illness required that I spend my adolescence on psychiatric wards. To this day I mourn the loss of those years. It was not until much later that I made a conscious effort to develop a sense of control, realizing that I had the power to decide what form my life would take and who I would be. For the next ten years, I did not require hospitalization. During that time, I was divorced from my first husband and married a community mental health center psychiatrist. Although I experienced some acute flare-ups of symptomatology during that period, I had no recurrence of persistent, disabling symptoms. When more serious symptoms returned about ten years later, I denied their existence. Having discontinued medications years earlier and now withdrawing from other forms of support, I experienced more symptoms. I decided to investigate a private psychiatric residential halfway house that one of the nurses at the hospital had told me about. I sought and gained admission to the program. Staff at this facility believed in my potential, and I began to develop confidence in myself. I was now ready to take control of my life. My estranged second husband and I moved into an apartment together, and I threw myself into the task of finding employment. None of these steps were accomplished easily, but the pieces of my periodically disrupted life were coming back together. Like those with other chronic illnesses, I know to expect good and bad times and to make the most of the good. I take my life very seriously and do as much as I can when I am feeling well, because I know that there will be bad times when I am likely to lose some of the ground I have gained. Professions and family members must help the ill person set realistic goals. I would entreat them not to be devastated by our illnesses and transmit this hopeless attitude to us. I would urge them never to lose hope, for we will not strive if we believe the effort is futile." As one can see, schizophrenia is a highly disruptive disease that has no regard for who it affects. Researchers and mental health professionals are committing vast amounts of time and energy to finding its cause and refining its treatment. Health care and lost resources cost approximately $33 billion per year in the United States alone (Torrey 2). Organizations of schizophrenic patients and families across the country offer their members support and comfort. Schizophrenia doesn't affect one person-it affects whole families. Works Cited Arieti, Silvano. "Schizophrenia." Encyclopedia Americana. 1992 ed. Baruk, Henri. Patients Are People Like Us. New York: William Morrow and Company, 1978. Chapman, Loren J. Grolier Multimedia Encyclopedia. Release 6. Computer Software. Creative Technology, 1993. IBM PC-DOS 3.3, 4MB, CD-ROM. Eysenck, H., W. Arnold, and R. Meili. Encyclopedia of Psychology. New York: Continuum Publishing Company, 1982. Hoffer, Abram and Osmond, Humphrey. How to Live with Schizophrenia. Secaucus: Carol Publishing Group, 1992. Honig, Albert. The Awakening Nightmare. Rockaway: American Faculty Press, 1972. Long, Phillip W. Schizophrenia: Youth's Greatest Disabler. Internet: Internet Mental Health, 1996. Sinclair, Lawrence. High Performance Consultants. Psyrix Corporation, 1995. Torrey, E. Fuller. Surviving Schizophrenia: A Family Manual. National Alliance for the Mentally Ill Pamphlet. Arlington, VA: Wilson, 1993. Walsh, Maryellen. Schizophrenia: Straight Talk for Family Friends. New York: William Morrow and Company, Inc., 1985 Willwerth, James. "The Souls that Drugs Saved." Time Oct. 1994: 78-81. Hurt 1 f:\12000 essays\health & humanities (196)\Schizophrenia.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Schizophrenia During the 1950s, mentally disordered people who were harmful to society and themselves could be treated with medications and were able to return safely to their communities. During the 1980s, the cost of health care increased more than any other cost in our national economy. As a result, strategic planning has been made to reduce costs. "The political decision made to deinstitutionalize chronic mental patients started with the appearance of phenothiazine medications. Dramatically reducing the instability influenced by psychosis, these medications were of great significance to many individuals with serious mental disorders. At both the state and federal levels, legislators looked at the high cost of long-term psychiatric hospitalization. Social scientists guaranteed them that community-based care would be in the best interests of all concerned: the mentally ill and the general, tax-paying public (Barry 13)." It was believed that a social breakdown syndrome would develop in chronically mentally ill persons who were institutionalized. The characteristics of this syndrome were submission to authority, withdrawal, lack of initiative, and excessive dependence on the institution. While deinstitutionalization was kindhearted in its primary logic, the actual execution of the concept has been greatly undermined by the lack of good community alternatives. At this time a large amount of the individuals using community mental health treatment services are the homeless. Nearly half of the homeless are chronically mental ill. These individuals are often separated from their families and all alone on the dangerous street. These homeless schizophrenics stay away from social structures such as community health treatment centers. Since they start a new life of independence they often stop taking their medications, become psychotic and out of place, and begin to live on the street. Since the schizophrenics are deinstitutionalized they are thrown into a whole new world of independence. Since their brain functions different than the usual human being they can't cope with the problems of life. The schizophrenics drive themselves crazy wanting to kill themselves and others in order to escape from this perplexing world. Schizophrenia is the most common psychoses in the United States affecting around one percent of the United States population. It is characterized by a deep withdrawal from interpersonal relationships and a retreat into a world of fantasy. This plunge into fantasy results in a loss of contact from reality that can vary from mild to severe. Psychosis has more than one acceptable definition. The psychoses are different from other groups of psychiatric disorders in their degree of severity, withdrawal, alteration in affect, impairment of intellect, and regression. The severity of psychoses are considered major disorders and involve confusion in all portions of a person's life. Psychosis is seen in a wide range of organic disorders and schizophrenia. These disorders are severe, intense, and disruptive. A person with a psychotic disorder suffers greatly, as do those in his or her immediate environment. Individuals suffering from withdrawal are said to be autistic. That is, the person withdraws from reality into a private world of his or her own. The psychotic individual is more withdrawn than a person with a neurotic disorder or any other mental disorder. The affect, mood, or emotional tone in a person with a psychotic disorder is immensely different from that of normal affect. In the mood disorders, one observes the exaggeration of sadness and cheerfulness in the form of depression and mania. In the schizophrenic disorders, affect may be exaggerated, flat, or inappropriate. In psychotic disorders, the intellect is involved in the actual psychotic process, resulting in derangement of language, thought, and judgment. Schizophrenia is called a formal thought disorder. Thinking and understanding of reality are usually severely impaired. The most severe and prolonged regressions are seen in the psychoses, regression. There is a falling back to earlier behavioral levels. In schizophrenia this may include returning to primitive forms of behavior, such as curling up into a fetal position, eating with one's hands, and so forth. The symptoms of schizophrenia usually occur during adolescence or early adulthood, except for paranoid schizophrenia, which usually has a later onset. The process of schizophrenia is often slow, with the exception of catatonia, which may have an abrupt onset. As an adolescent, a person who later develops schizophrenia is often antisocial with others, lonely, and depressed. Plans for the future may appear to others as vague or unrealistic. It is possible that there may be a preschizophrenic phase a year or two before the disorder is diagnosed. This phase may include neurotic symptoms such as acute or chronic anxiety, phobias, obsessions, and compulsions or may reveal dissociative features. As anxiety mounts, indications of a thought disorder may appear. An adolescent may complain of difficulty with concentration and with the ability to complete school work or job-related work. Over time there is severe deterioration of work along with the deterioration of the ability to cope with the environment. Complains such as mind wandering and needing to devote more time to maintaining one's thoughts are heard. Finally, the ability to keep out unwanted intrusions into one's thoughts becomes impossible. As a result, the person finds that his or her mind becomes so confused and thoughts so distracted, that the ability to have ordinary conversations with others is lost. The person may initially feel that something strange or wrong is going on. He or she misinterprets things going on in the environment and may give mystical or symbolic meanings to ordinary events. The schizophrenic may think that certain colors hold special powers or a thunderstorm is a message from God. The person often mistakes other people's actions or words as signs of hostility or evidence of harmful intent. As the disease progresses, the person suffers from strong feelings of rejection, lack of self-respect, loneliness, and feelings of worthlessness. Emotional and physical withdrawal increase feelings of isolation, as does an inability to trust or sociate with others. The withdrawal may become severe, and withdrawal from reality may be noticeable from hallucinations, delusions, and odd mannerisms. Some schizophrenics think their thoughts are being controlled by others or that their thoughts are being broadcast to the world. Others think that people are out to harm them or are spreading rumors about them. Voices are usually heard in the form of commands or belittling statements about his or her character. These voices may seem to appear from outside the room, from electrical appliances, or from other sources. There are many different factors that lead to schizophrenia. The main way to acquire schizophrenia is through heredity. A person has a 46% chance of getting schizophrenia if his or her mother and father has it. One identical twin has a 46% chance of getting schizophrenia if the other twin acquires it (Coon 546). There are also some environmental factors that lead to schizophrenia. One is if the mother gets the flu during the second trimester of pregnancy causing brain damage to the unborn child. Another factor is complications at birth that could affect the child mentally. Another factor causing schizophrenia is stress because the mind is overworked and eventually can't function properly. An important factor concerning schizophrenia is how a child is raised. If the child has abusive parents, he or she will have serious mental problems in the future. Early in this disease, there may be obsession with religion, matters of the supernatural, or abstract causes of creation. Speech may be characterized by unclear symbolisms. Later, words and phrases may become puzzling, and these can only be understood as part of the person's private fantasy world. People who have been ill with schizophrenia for a long time often have speech patterns that are disoriented and aimless and deficient of meaning to the casual observer. Sexual activity is frequently altered in mental disorders. Homosexual concerns may be associated with all psychoses but are most prominent with paranoia. Doubts concerning sexual identity, exaggerated sexual needs, altered sexual performance and fears of intimacy are prominent in schizophrenia. The process of regression in schizophrenia is accompanied by increased self-fixation, isolation, and masturbatory behavior. The schizophrenic person finds himself or herself in a painful dilemma. He or she retreats from personal intimacy or closeness because of the intense fear that closeness will be followed by ensuing rejection or harm. This retreat from intimacy leaves the person lonely and isolated. This dilemma often becomes the nurse's dilemma. The nurse wishes to form a productive emotional bond but at the same time seeks to lessen the client's anxiety. For the schizophrenic person, moves toward emotional closeness will eventually increase anxiety. The dopamine theory of schizophrenia is based on the action of the neuroleptic drugs, better known as antipsychotic drugs. Neuroleptics are the drugs of choice for treating the symptoms of schizophrenia. The neuroleptics are believed to block the dopamine receptors in the brain, limiting the activity of dopamine and reducing the symptoms of schizophrenia. Amphetamines, just the opposite, enhance dopamine transmission. Amphetamines produce an excess of dopamine in the brain and can provoke the symptoms of schizophrenia in a schizophrenic client. In large doses, amphetamines can simulate symptoms of paranoid schizophrenia in a nonschizophrenic person. Some symptoms of schizophrenia are due basically to hyperdopaminergic activity. Other symptoms, such as apathy and poverty of thought, are related to neuronal loss. Drugs reduce most of the disturbing, disorganizing, and destructive aspects of the schizophrenic person's behavior. Drugs, however, do not improve or affect the fundamental stupor, unresponsiveness, lack of ambition, and symbolic defects. Group therapy is especially useful for clients who have had one or more psychotic breaks. It has been shown that groups can benefit the client in the development of interpersonal skills, resolution of family problems, and the effective use of community supports. Groups allow opportunities for socialization in safe settings, the expression of tensions, and sharing problems. The most useful types of groups for schizophrenics are groups that help the client develop abilities to deal with such issues as day-to-day problems, sharing consistent experiences, learning to listen, asking questions, and keeping topics in focus. Groups available on an outpatient basis over a long period of time allow for individual growth in these areas. It would help greatly if better rehabilitation programs were offered after hospital treatment. One such approach is the use of half-way houses, which can ease a patient's return to the community. The half-way houses offer patients supervision and support, without being as restrictive as hospitals. They also keep people near their families. Most important, half-way houses can reduce a person's chances of being readmitted to a hospital. Although the therapy and drugs help the schizophrenics deal with their problems tremendously there is not enough to go around because states are closing their mental institutes for financial reasons. Even though the cost of mental institutes are high, the schizophrenics are better off being kept in them because they could cause a huge uproar on the streets. Without the mental institutes the schizophrenics will get worse because they are unable to live independently. Many schizophrenics might even be harmful to society because their brain is out of control. The paranoid schizophrenics could go on a rampage and try to kill everyone in sight because they think that everyone is out to hurt them. This could be the future of our world if we don't take time to treat these schizophrenics who desperately need it no matter what the cost. Works Cited Barry, Patricia D. Mental Health and Mental Illness. Philadelphia: J. B. Lippincott, 1994. Coon, Dennis. Introduction to Psychology. New York: West Publishing Company, 1995 McCuen, Gary E. Treating the Mentally Disabled. Hudson, Wisconsin: Gary E. McCuen, 1988. Varcarolis, Elizabeth M. Psychiatric Mental Health Nursing. Philadelphia: W. B. Saunders, 1990. f:\12000 essays\health & humanities (196)\Sexually Transmitted Diseases Report.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ TABLE OF CONTENTS I . Sexually transmitted diseaeses defined II. Genital Herpes III. Vaginal Candidiasis IV. Chlamydia V. Prevention VI. Bibliography SEXUALLY TRANSMITTED DISEASES DEFINED A sexually transmitted disease is not the same as genital disease. Most genital diseases are not caused by sexually transmitted organisms. But most sexually transmitted infections do involve the genitals. Infection of the rectum, throat, and the eye are also common. Alot of sexually transmitted diseases spread from a single place and produce sores on parts of the body. At least a dozen diseases are sexually transmitted. Sexually transmitted diseases occur mainly in people 15 to 30 years of age. But sometimes people are born with it because of an infected mother. People with a sexually transmitted Disease are usually at high risk for catching other diseases. There are more male infections reported than female cases. This is caused by prostitutes and homosexual contacts. 50 percent or more infections result from homosexual contacts. Other infections like syphilis, herpes, and HIV infection may be passed on to the fetus or during childbirth. The fetus or baby can suffer from the disease and can die from it. The helping of STDs has three parts: treatment, counseling, and following up. Sometimes treatment is given in a single dose but in sometimes you have to take it more than once. A person can still be infected even if the symptoms go away. That is why a follow-up visit is important. To avoid spreading the infection the person should not have sex until the doctor says that it is cured. It can take up to fourteen days. This stops the Ping Pong effect. GENITAL HERPES This infection is caused by the Herpes simplex virus. The symptoms are similar, and can result from either oral-to-genital or genital-to-genital contact. The virus causes blisters on the genitals, similar to the cold sores that occur on the mouth. Cold sores on the mouth are also caused by the herpes virus. These infections are caused by viruses cures are not available. It has been estimated that approximately 1 in 6 people in Australia has had a history of genital herpes at some time. Not all people infected with the herpes virus will have symptoms. As many as 60-70% of people with herpes virus type 2 infection by a blood test have not had symptoms diagnosed as genital herpes. Things occur most often on the penile shaft, glans or anal area and on the labia, clitoris,vagina or cervix. They also are around the mouth or on the throat after oral sex. . Genital herpes is usually more painful in women Vaginal and blisters may be so painful that women become unable to pass urine. It is important to get early treatment in order to prevent this from getting worse. Some symptoms happen for 1 to 3 weeks. Herpes lives in the body between symptoms. Relapses can happen by emotional or physical stress, fever, trauma, hormonal changes, sunlight, alcohol. There are two different Infections Asymptomatic Infections and Neonatal Infections. Genital herpes can be passed on through most forms of sexual contact, genital-to-genital, oral-to-genital, and mutual masturbation. Many people are unaware that cold sores may cause genital infection during oral sex. It is also possible for a person to transfer herpes from their own mouth to their genitals, and to their eyes. Condoms may further reduce spread between attacks. Some treatments that can relieve discomfort: Keeping sores clean and dry Wrapping an ice-block in a towel Bathing in salt water Drinking plenty of water If urination is painful, urinating in a hot bath or, for women, using both hands to separate the lips of the vulva to achieve a free stream of urine, preventing urine from touching the ulcers. Wearing loose, cotton underpants and avoiding tight trousers aspirin Anti-Herpes Drugs: Acyclovir The use of condoms during vaginal and anal intercourse reduces the risk of genital herpes, but protects only those areas in contact with the condom. Because herpes can be transmitted from mouth-to-genitals condoms or dental dams may be used during oral sex. If there are sores , it is important to avoid oral sex. Because herpes can be spread by the hands between people, it is important to wash your hands if they have come into contact with sores. VAGINAL CANDIDIASIS ("THRUSH", MONILIA, YEAST) The yeast like organisms that cause candidiasis are very common and normally are in the vagina as well as the mouth and in the intestines of most people. Candida is not an actual STD. It is seen in most sexually active people. The presence of candida doesn't usually have symptoms. There is a change in the pH of the vagina and may cause a problem in the balance of the normal flora. As a result, candidal overgrowth can occur and then cause symptoms. Some things that cause symptoms are heat, moisture, diabetes, steroid medications, cancer, chronic infection, and malnutrition . Men can also get candidiasis, which causes balanitis which causes inflammation of the glans penis. This usually happens to uncircumcised men who still have a foreskin which gives moist conditions for candidal overgrowth. Some symptoms are itchiness in the anal and genital area, which intensifies at night, smooth to firm vaginal pus discharges, inflamed, split, and abraded skin and Inflammation of the glans penis. There is some treatment to change some of the factors that prevent the organism to spread. Minor vaginal candidiasis is treated with anti fungal agent in the form a capsule of nystatin which is inserted into the vagina, or a vaginal cream. Another way to treat this is natural yoghurt which can be inserted into the vagina or a vinegar and water douche. Genital and oral antifungal therapy can be effective also, however, thrush can always recur because candida lives in the bowel. Candida cannot be permanently taken care of. Carefully washing and drying of the anal and genital area using soap helps somewhat. CHLAMYDIA Chlamydia grows within cells. Chlamydia usually infects the cervix and fallopian tubes of women and the urethra of men. Chlamydial infections are said to be the most common of all STDs. It is also said that in a population of 15 million, there are up to 300,000 cases of chlamydia each year. There are many undiagnosed cases of chlamydia in the community. It has been estimated that the true population of chlamydia in sexually active people may be in the order of 5% to 10%. Chlamydia often produces no symptoms. 60% of women and 40% of men have no symptoms. Infection of the cervix and fallopian tubes occurs more, and chlamydia can also cause urethral infection. Symptoms can include pain in urination, bladder infection, a thin vaginal discharge of pus and lower abdominal pain. Inflammation of the cervix with pus is very common. Eye infections in infants born of infected mothers can also occur. In men, chlamydia may produce inflammation of the urethra similar to gonorrhoea. Symptoms for men may include discharges also. The most severe complication of chlamydia, is the risk of pelvic inflammatory disease (PID). As a result of infection to women it travels into the upper genital tract. Chlamydia can also lead tothe genital tract in men causing epididymitis,although this is much less common for men than for women. The risk of infection from person-to-person is alot like gonorrhoea. It can also be passed to the eye by a hand moistened with infected fluids. Chlamydia can be transmitted during anal intercourse causing inflammation of the rectum. Chlamydial infections are treated the best with a drug doxycycline, taken orally for 10 days. Other infections, such as PID, require longer treatment. For prevention, use of condoms during vaginal and anal intercourse works well. Because chlamydia can infect the eyes, care must be taken to avoid spreading sexual fluids into them. PREVENTION OF SEXUALLY TRANSMITTED DISEASES Some ways to reduce the chance of having sexual contact with a person infected are: 1. If you are born of uninfected and not having sex. Which makes life fairly uninteresting. 2. Being careful in selecting your partners. 3. If you cannot resist having sex with every person you have a relationship with, you can examine your sex partner by looking them to actually see if they have an infection. 4. Use of a condom helps the risk of passing on the infection 5. After unprotected sex with your sex partner you should go to the doctor and make sure you didn't catch anything. 6. If medical treatment is started, IT IS VERY IMPORTANT TO MAKE SURE YOU GO TO THE DOCTOR FOR RE-EXAMINATIONS UNTIL THE DOCTOR SAYS YOUR INFECTION IS CURED. How to know if you have an STD. 1.Discharge of fluid from the penis or vagina 2.Pain or irritation when urinating or having sex. 3.Sores, blisters, warts, lumps or rashes anywhere in the genital or anal area. 4.Itchiness or irritation in the genital or anal area 5.Frequent diarrhea If you have any of these, you should see a doctor at once. Do not wait for them to go away,even if they do, this does not mean the disease is gone. Most STDs can go undetected and cause serious illness later. Having no symptoms doesn't mean that you do not have a STD. How to avoid STDs. It is not hard to avoid getting STDs. The risk can be reduced by using condoms during vaginal or anal sex. Scientific research has shown that latex condoms are an effective against HIV and the viruses and bacteria that causes STDs. Condoms, will only protect you against disease if you use them every time you have sex. Sometimes is not good enough. Another way to avoid STDs not to have sex at all. Kissing,touching and masturbation. To have sex only with a partner who has no other sexual partners is an assuring way also. Bibliography CLINIC 275 FIRST FLOOR, 275 NORTH TERRACE ADELAIDE SOUTH AUSTRALIA 5000 TELEPHONE: +61 (8) 8226 6025 FACSIMILE: +61 (8) 8226 6560 COUNTRY CALLERS (South Australia only): 1 800 806 490 Web site designed and maintained by Dr Christopher Miller email: csm@hc2.health.sa.gov.au Sexually Transmitted Diseases Control Branch Public and Environmental Health Division South Australian Health Commission PO Box 6 Rundle Mall Adelaide SA 5000 Australia f:\12000 essays\health & humanities (196)\Should Euthanasia In Florida Be Legalized .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Florida should legalize euthanasia and I offer the following plan. The way Florida would legalize euthanasia should be by setting up a set of professional doctors who could examine all cases in which a person or an ill patients family request euthanasia due to extreme pain or an incurable disease. The doctors could examine these people and if they find there is no way other than the use of machines 24-hours a day to keep these people alive they will allow the doctor of the patient to assist in suicide or in better terms freeing an immense pain and agony. The benefits from legalizing euthanasia in Florida would be the health care spent to keep many of the people who live on machines from terminally or incurable diseases would be saved, many families would not have to watch there family member die slowly, and many stories like Sue Rodriguez's would never be. In the first place, health care on people with incurable or deadly diseases cannot be paid by many people because of no medical insurance according to Euthanasia questions by the IAETF. The government jumps in and pays for the treatment and care. This could be replaced in incurable or agonizing pain situations with the better and cheaper treatment of death. Next, not all family life is harmonious, and underlying pathology can often be exacerbated by the stresses of a family member's terminal illness bring says an article in Law Medicine & Health Care of 1992. If euthanasia is legalized the family members of a patient could sleep peacefully knowing that they have been "mercied" and died easily and with little pain instead of being kept alive by a machine or dying slowly and painfully from an incurable disease. Finally, let me tell you a true story from Vess Fast Access TO Information On Euthanasia, about a 31-year old mother named Sue Rodriguez. Sue Rodriguez was dying slowly of the incurable Lou Gehrig's disease. She lived several years with the knowledge that the disease would one by one waste away her muscles until the point while still conscious the lack of muscles would choke her to death. She begged the courts to allow her and her doctor to choose the moment of her death instead of the inspicable pain of being choked to death. The court refused to mercy her and she lived in terror every day. Every morning she would wake up wondering if this is the day she would be choked to death maybe while her children watch. In February 1994, Sue Rodriguez died. Finally she may rest in peace after several years of pain. If euthanasia was legalized it could have saved her the nightmare during those months and years before her death, given her the confidence to carry on - with the reassurance that when it got too bad she could rely on a compassionate doctor to follow her wishes at the end. To recap, Florida should legalize euthanasia and I offer this plan. A set of doctors to examine each euthanasia case is a way to legalize euthanasia with many safe guards for people who do not have to die. The benefits of the legalization of Euthanasia in Florida would be the amount of money saved that is spent on keeping incurable patients alive, families of victims could live peacefully and not go under much stress knowing the victim died peacefully and not painfully, and how stories like the one of the 31-year old mother Sue Rodriguez and how she woke up every day wondering if she would choke to death in front of her children and family because the courts would not allow her and her doctor to choose the time of death. To conclude, I ask you to vote affirmatively on if Florida should legalize euthanasia. f:\12000 essays\health & humanities (196)\Sickle Cell Anemia.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Sickle Cell Anemia is a genetic disease that affects all kinds of people and can start before a person is even born. This paper will talk about symptoms of Sickle Cell Anemia, the people affected, the cause of the disease, how the disease is diagnosed, and cured. Symptoms of Sickle Cell Anemia are pale skin, short of breath, easily tired, and whites of eyes turn yellow. Ethnic or special groups affected with Sickle Cell Anemia are mostly blacks, and Hispanics of Caribbean ancestry. The disease also affects some people of Arabian, Greek, Maltese, Sicilian, Sardinian, Turkish, and Southern Asian ancestry. How transmitted type of gene or chromosomes that causes the disease. Sickle Cell Anemia is a sex linked gene. One way somebody could get this disease is if both parents are a carrier for Sickle Cell Anemia. There is one in four chance that a baby will have the disease. How the disease is diagnosed. Doctors are able to diagnose the Sickle Cell Anemia disease by looking at symptoms that cause the disease, also by looking at blood through a microscope. There is no cure for this disease yet. Specialists are still searching for a cure. Sickle Cell Anemia is a genetic disease that affects all kinds of people and can start before a person is even born. This paper will talk about symptoms of Sickle Cell Anemia, the people affected, the cause of the disease, how the disease is diagnosed, and cured. Symptoms of Sickle Cell Anemia are pale skin, short of breath, easily tired, and whites of eyes turn yellow. Ethnic or special groups affected with Sickle Cell Anemia are mostly blacks, and Hispanics of Caribbean ancestry. The disease also affects some people of Arabian, Greek, Maltese, Sicilian, Sardinian, Turkish, and Southern Asian ancestry. How transmitted type of gene or chromosomes that causes the disease. Sickle Cell Anemia is a sex linked gene. One way somebody could get this disease is if both parents are a carrier for Sickle Cell Anemia. There is one in four chance that a baby will have the disease. How the disease is diagnosed. Doctors are able to diagnose the Sickle Cell Anemia disease by looking at symptoms that cause the disease, also by looking at blood through a microscope. There is no cure for this disease yet. Specialists are still searching for a cure. Sickle Cell Anemia is a genetic disease that affects all kinds of people and can start before a person is even born. This paper will talk about symptoms of Sickle Cell Anemia, the people affected, the cause of the disease, how the disease is diagnosed, and cured. Symptoms of Sickle Cell Anemia are pale skin, short of breath, easily tired, and whites of eyes turn yellow. Ethnic or special groups affected with Sickle Cell Anemia are mostly blacks, and Hispanics of Caribbean ancestry. The disease also affects some people of Arabian, Greek, Maltese, Sicilian, Sardinian, Turkish, and Southern Asian ancestry. How transmitted type of gene or chromosomes that causes the disease. Sickle Cell Anemia is a sex linked gene. One way somebody could get this disease is if both parents are a carrier for Sickle Cell Anemia. There is one in four chance that a baby will have the disease. How the disease is diagnosed. Doctors are able to diagnose the Sickle Cell Anemia disease by looking at symptoms that cause the disease, also by looking at blood through a microscope. There is no cure for this disease yet. Specialists are still searching for a cure. f:\12000 essays\health & humanities (196)\Skin Cancer.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Gone are the days when people sent children outside to play to get a little color in their cheeks. They know too much about the dangers of unprotected sun exposure and the threat of skin cancer. Or do they? Despite the fact that 58% of parents remembered hearing about the importance of protecting their children from the sun, children are still playing in the sun without sunscreen or protective clothing (3., p 1). Sunburn is the most preventable risk factor of skin cancer. Skin type and family history cannot be changed. Protection from the sun and education of the potential hazards of the sun need serious attention. The American Cancer Society estimates that over 850,000 cases of skin cancer will occur in the United States during 1996. Of those cases, they predict that 9,430 will end in death (4., p 1). Apparently, Americans still do not have an adequate amount of prevention information to help reduce the disfigurement and mortality from this cancer. Exposure to the ultraviolet radiation from the sun is the most frequently blamed source of skin cancer. Due to the reduction of ozone in the earth's atmosphere, UV radiation is higher today than it was several years ago. Ozone serves as a filter to screen out and reduce the UV light that reaches the earth's surface and its people. Very simply, sunburn and UV light can damage the skin and lead to skin cancer (1., p 1). The American Cancer Society also faulted repeated exposure to x-rays, artificial forms of UV radiation like tanning beds, and contact with chemicals like coal tar and arsenic as other causes of skin cancer (4., p 1). Additionally, if there is a history of skin cancer in the family, an individual may be at a higher risk (1., p 1). Individuals who have experienced only one serious sunburn have increased their risk of skin cancer by as much as 50% (1., p 4). There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Basal cell carcinoma usually imposes itself on areas of the skin that have been exposed to the sun. It usually appears as a small raised bump with a smooth shiny surface. Another type resembles a scar that is firm to the touch. Although this specific type of skin cancer may spread to tissue directly surrounding the cancer area, it usually does not spread to other areas of the body (9., pp 2-3). Squamous cell carcinoma growths also appear most frequently on areas of the body that have been exposed to the sun. These areas can include the hands, lower lip, forehead, and the top of the nose. Additionally, skin that has been exposed to x-rays, chemicals, or has been sunburned can host these tumors. The squamous tumors may feel scaly or develop a crusty appearance. Some growths may bleed. These particular tumors may spread to lymph nodes in the surrounding area (9., pp 2 -3). Malignant melanoma is a far more serious type of skin cancer. It can spread quickly to other parts of the body through the lymph system or blood. This type of skin cancer is more common among adults. Findings have indicated that men most often develop melanoma on the trunk of the body. Whereas, women most often develop it on the arms and legs (6., pp 2-3). The warning signs of melanoma are: changes in the color, size, or shape of a mole, bleeding or oozing from a mole, or a mole that is hard, lumpy, swollen, and is tender to the touch, or feels itchy. A new mole can also be an indicator of melanoma. A simple "ABCD" rule outlines the warning signs of melanoma. "A" is for asymmetry. One half of the mole does not match the other. "B" is for border irregularity. The edges are ragged, notched, or blurred. "C" is for color. The pigmentation is not uniform. "D" is for a diameter of greater than 6mm. Any progressive increase in size should be of particular concern (8., p 1). For both basal and squamous cell carcinomas, surgery is the most common treatment. Electrosurgery is the process in which the cancer is scooped out with a sharp instrument and then an electric current is used to burn the edges around the site to kill any remaining cancer cells. Cryosurgery freezes the tumor to kill the diseased tissue with liquid nitrogen. Simple excision cuts the cancer from the skin along with some of the healthy tissue around it. Micrographic surgery removes the cancer and as little normal tissue as possible. During this surgery, the doctor removes the cancer and then uses a microscope to look at the cancerous area to make sure no cancer cells remain. This particular treatment has the highest 5-year cure rate. Laser therapy uses a narrow beam of light to remove the cancer cells. Surgery may leave a permanent scar on the skin. Depending on the size of the cancer removed during surgery, skin grafting may be necessary. Radiation therapy uses x-rays to kill cancer cells and shrink tumors. Chemotherapy uses drugs to kill the cancer cells. Topical chemotherapy is often administered as a cream or lotion placed on the affected skin to kill the cancer cells. Systematic chemotherapy is a treatment administered in the form of a pill or injection. This allows the drug to enter the bloodstream, travel through the body and kill cancer cells. Systematic chemotherapy is in the process of being tested in clinical trials. Biological therapy, or immunotherapy tries to get the person's own body to fight the cancer. It uses materials made from the infected person's body to boost, direct, or restore the body's own natural defenses against the cancer. Photodynamic therapy uses a certain type of light and a special photosensitive chemical to kill cancer cells (9., pp 2-5). Malignant melanoma is classified by stages. In Stage 0 melanoma, abnormal cells are localized to the outer layer of the skin cells and do not invade deeper tissues. At stage I, cancer is found in the epidermis and/or the dermis, but it has not yet spread to nearby lymph nodes. The tumor measures less than 1.5 millimeters thick. At stage II, the tumor measures 1.5 millimeters to 4 millimeter thick. The cancer has spread to the lower part of the dermis, but not into the tissue below the skin or into the nearby lymph nodes. At stage III, indications are that the tumor has spread to nearby lymph nodes or there are additional growths between the original tumor and the lymph nodes in the area. At stage IV, the tumor has spread to other organs or to lymph nodes far away from the original tumor. The type of treatment is based on the stage of the cancer. Four of the most common kinds of treatments are: surgery, chemotherapy, radiation therapy, and biological therapy. Surgery is the primary treatment for all stages of melanoma. After surgery, chemotherapy is normally used to kill any cancer cells that may remain (6., pp 2-5). Individuals that have treatment for basal cell carcinoma should be clinically examined every 6 months for at least 5 years. Thereafter, an examination for recurrent growths or new tumors should be done on an annual basis. It has been found that 36% of individuals who develop a basal cell carcinoma will develop a second primary basal cell carcinoma within 5 years. Since squamous cell carcinomas have definite metastatic potential, these patients should follow a 3 month re-examination schedule for the first several years, and then follow a 6 month schedule of examinations for an indefinite period of time (10., pp 4-6). Overall, there is an increased incidence of second primary melanomas in affected individuals. A minimum of 3 percent will develop second melanomas within 3 years. Thus, patients need close follow up for the development of subsequent primary melanomas. An appropriate interval of re-examination may be 6 months for patients with atypical moles and without a family history of melanoma. If patients have not shown evidence of recurrence or a second primary melanoma by the second anniversary of diagnosis, the interval between examinations can be extended to 1 year. For patients with atypical moles, or a positive family history of melanomas, examinations should be considered every 3 to 6 months (11). The American Cancer Society reports that basal cell carcinoma, the most prevalent skin cancer, and squamous cell carcinoma have a notable prognosis if detected and treated early. Although, individuals with non-melanoma skin cancers are at a high risk for developing future skin cancers. While melanoma is the rarest of the skin cancers, it is the most deadly (7., pg. 1). The American Cancer Society also states, "Malignant melanoma can spread to other parts of the body quickly; however, when detected in its earliest stages, and with proper treatment, it is highly curable. The 5-year relative survival rate for patients with malignant melanoma is 87%. For localized malignant melanoma, the 5-year relative survival rate is 94%; and rates for regional and distant disease are 60% and 16%, respectively. About 82% of melanomas are diagnosed at a local stage" (8., p 2). When the statistics show that over one million new cases of skin cancer will be diagnosed in the United States this year, Americans have their work cut out for them. By the year 2000, Americans will have a 1 in 75 lifetime risk of developing melanoma or other skin cancers (5., p 1). Early detection is by far the most crucial element of surviving this terrible disease. Changing society's belief that being tanned connotes health and beauty continues to be a challenge. The notion has to be replaced with the belief that staying out of the sun, or taking extreme precautions while in the sun is smarter. f:\12000 essays\health & humanities (196)\Sleeping Disorders.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ I am going to start by telling you what a sleeping disorder is. A sleeping disorder is a problem that affects something to do with sleep. Not all sleeping disorders have symptoms that are obvious to a person or their family and friends, here are some common sleep disorders. · Insomnia · Sleep Apnea · Narcolepsy · Restless Leg Syndrome · Parasomnia · Bruxism · Jet Lag · Shiftwork I will be discussing the sleeping disorders listed above and what symptoms they can cause. Insomnia is a chronic sleeping disorder in which it is very difficult to start and continue sleeping. One of the other symptoms of insomnia that is most recognized is waking up repeatedly in the middle of the night. Lack of sleep leads to two other things, daytime fatigue and restlessness. These are bad on the job and at school while doing tests or other important work. The amount of sleep that each person needs to feel alert during the day varies. If you have a night of sleep which is much less than the amount of sleep you need, then you will more than likely feel quite sleepy the next day. Thirty-three percent of adults in America have a case of insomnia at least once in their life. Most cases only last one or two nights, but insomnia can continue for weeks or possibly even months. There have only been three standard types of insomnia that have been identified by doctors. They are as follows: · Transient insomnia is considered a few sleepless nights that is usually brought on by stress, excitement, or environmental changes. A person could have trouble sleeping the evening before a big meeting or shortly after a breakup or a fight with his girlfriend. · Short-term insomnia is usually two or three weeks of poor sleep caused by continual stress at work or at home, as well as medical and psychiatric illnesses. Eliminating the source of the stress usually takes care of the irregular sleep patterns · Chronic insomnia is considered poor sleep that lasts two weeks or longer. It can possibly be related to medical, behavioral, or psychiatric problems. Usually poor sleep leads to decreased feelings of well-being. Chronic insomnia can usually recur. If difficulty sleeping was the only problem with insomnia, then it wouldn't be so bad. Some of the other problems it can cause is anxiety in noticeably impaired concentration and memory. To keep episodes of insomnia at a minimum, sleep specialists recumbent practicing good sleep hygiene. There is another sleeping disorder called Sleep Apnea. Sleep Apnea is not really problems with going to sleep, it is more dealing with problems while you are sleeping. Some of the symptoms of sleep apnea include · loud or irregular snoring · excessive daytime sleepiness · repeated nightly arousals · non-refreshing sleep · morning headache · nightly periodic absent breathing Loud snoring at night can be more than just a nuisance. It can actually signal to you that something could be wrong with breathing during sleep. In most cases, there are no serious medical consequences associated with snoring. But for about 20 million Americans, this loud, habitual snoring can indicate a life-threatening disorder know as sleep apnea. An apnea is actually a lack of breath. For most people during sleep, it is normal for the breathing muscles to relax. The problem is, for some people, excessive muscle relaxation occurs which disrupts breathing. Disordered breathing during sleep also can occur if the brain stops sending the needed messages to the breathing muscles. In either case, the presence of apnea should be taken seriously. Sleep apnea is more common in middle-aged men and overweight people. People with sleep apnea often complain of insomnia or excessive daytime sleepiness. Waking up with headaches is another symptom of sleep apnea. So is impaired memory and concentration. Problems arising from sleep apnea can include heart and lung disease, and can also cause heart failure in severe cases. There are three typical forms of sleep apnea, with varying degrees of respiratory movements. · Obstructive Apnea is the most common and severe form. It is associated with an upper airway obstruction and a loss of airflow even though the respiratory muscles are active. When muscles of the soft palate at the base of the tongue and uvula relax and sag, the block the airway and cause loud, labored breathing. When breathing stops, pressure builds up until the sleeper lets out a gasp for air. Each gasp causes a mini-awakening. People with obstructive apnea can stop breathing for 10 seconds or more, several hundred times a night. Snoring is present. · Central Apnea is when the airway remains open but the diaphragm and chest muscles stop working. As oxygen levels in the blood stream decrease, the sleeper will awaken and resume breathing. Several awakenings during the course of a night usually occur, sometimes accompanied by gasps or choking sounds. Complaints of insomnia and an inability to maintain sleep are common. Snoring will not necessarily be present. · Mixed apnea occurs when the sleeper experiences a brief period of central apnea normally followed by a longer period of obstructive apnea. For this reason people with mixed apnea often snore. Mixed apnea is common among people with sleep apnea. Treatment for sleep apnea varies depending on the type of apnea and the individual patient needs. Sleep apnea syndrome caused by the soft tissue of the throat collapsing during sleep is often treated with a device known as CPAP (Continuous Positive Airway Pressure). The compressor creates air pressure that is sent through the airway of the sleep apnea patient, keeping it open to allow the patient to sleep and breathe normally. Parasomnias are a type of sleep disorder that can intrude into or interrupt the sleep process. The are disorders of arousal, partial arousal and sleep-stage transition. The following are common examples of parasomnias. Sleepwalking Episodes of sleepwalking can range from a person sitting up in bed to more complex activities like preparing a meal. Although the sleepwalker may be unaware of their environment, they often show an ability to navigate through their house or wherever they may be without serious harm. However, there is a danger of the sleeper falling or walking outside. Trying to stop a sleepwalker is often met with resistance. Sleepwalkers can experience emotional distress and embarrassment because of their nighttime activities, keeping them from staying with friends or vacationing. Sleepwalking is most common in children and normally disappears with the coming of puberty. Sleep Talking While sleeping, a person may begin talking without reason. The sleeper may say a comprehensible speech, single words or other sounds. Typically, the sleep talker is not aware of what they are saying. The talking is often said without emotion, but can be associated with stressful shouting. Other than the irritation or distress it may cause loved ones, sleep talking is harmless. It is often a temporary phenomenon brought on by stress or illness, but it can continue for many years. Sleep talking frequently occurs with other sleep disorders, such as obstructive sleep apnea and sleep terrors. Sleep Eating The causes of sleep-related eating are many. Most of them arise from a background of more conventional sleepwalking. In some cases, the sleep-related eating was brought on by medications prescribed for depression or insomnia. It may be a display of other sleep disorders, such as obstructive sleep apnea or periodic limb movements. The "sleep-related eating disorder" has only recently been described. Common concerns about this disorder are excessive weight gain, choking while eating, potential injury from starting fires while cooking or cutting oneself while preparing food, and sleep disruption. Approximately two-thirds of those afflicted with this disorder are women and the symptoms typically begin in the late 20s. The overwhelming majority do not suffer from a waking eating disorder. Sleeping disorders can be very weird, I did not know that until I wrote this paper. I was not aware that people could eat in their sleep, I thought that only happened in TV I have learned a great deal from this paper and I hope you did also. f:\12000 essays\health & humanities (196)\small pox 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Small pox, which was once the most feared disease known by mankind started out in the days of Christopher Columbus. The disease set out to change the lives of the people in the worse way. It became known as an epidemic disease that ended up killing hundreds of people. Small pox started out in Hispaniola and because of no cure, it traveled to the island of Puerto Rico, and then Cuba. It was only a matter of time until it spread to the mainland, somewhere in America. In the Middle Ages, small pox was a highly contagious disease which often lead to death if not treated. In this term paper you will read and learn about the causes, symptoms and treatments of this horrible disease. Small pox which was often refereed to as a life threatening disease, is caused by a virus, which was not discovered until the nineteenth century. Most of the victims whom acquired small pox, was a result of face to face contact. It is passed through the nose where tiny particles are released when the infected person sneezes, also by the mouth where particles are once again ejected when the victim coughs. The disease can be transmitted by dried small pox scabs and through materials the infected person has come in contact with. The virus is reproduced in the lymphoid tissue and released into the body. Virus reproduction begins when the virion comes into contact with a suitable host cell. The virus must interact with a receptor on the cell surface. The infectious cycle usually consists of two stages. The first stage makes the proteins necessary for the protein to form. The second stage forms the adult virion to start the attack on the body. Smallpox attack with no warning. There are several painful symptoms that are brought upon by this disease. In most of the cases, symptoms in a new victim will occur ten to twelve days later. Patients will develop chills, high fever, and nausousness. The fevers may reach up to 105 degrees farenht. In three or four days later a rash erupts and the fever and discomfort may subside. It begins on the face, then spreading to the chest, arms, back and finally the legs. It consists of hard red lumps which become pimple like, swelling and containing puss. "The pustules gave the disease its name, by which it was first known in the west as Variola" (Giblin 59). This rash itches severely but scratching must be avoided in order to prevent another infection from forming. "Up to forty percent of the patients died, in the rest, scabs eventually formed and then fell off, leaving permanent pits and scars in the skin" ( Lawrence 365). Some of the patients were also left blinded. The victims who were faced with this dreadful disease, suffered terribly. In some cases if sever enough the patient would lose the battle with smallpox and die. Sometimes the rash would never heal completely and cause an acne type look on the persons body. There is no medication to clear up the acne it is perminit, sometimes worse than others. In 1796, Edward Jenner, a British physician, developed the first vaccine to prevent small pox (Johnston 92). At the age of eight he experienced a painful fight with small pox. This was his inspiration to discover a method to prevent the suffering of small pox victims. The news of this marvelous development spread quickly and it was soon used widely around the world. During the 1800's many countries required everyone as a law, to receive the vaccine. It was recognized that the vaccine was the best quality and the disease continued to spread. The vaccination contained the virus that causes cowpox, this disease is similar to small pox but a milder form. This causes the production of antibodies that give protection against both cowpox and small pox. There is no specific treatment for small pox. Due to the disease being so contagious, patients need to be isolated until they are completely recovered. The sores must be kept clean and penicillin and sulfa medications are sometimes given to prevent further infections. However, after a person has come across the disease and recovers from it they become permanently immune to the virus. Jenner later promoted the smallpox vaccination and ultimately wiped the virus clear out. Since then there has only been one case of smallpox but they are not certain that it really was the smallpox virus or just a clone of a chicken pox virus. Vaccinations only work depending on ones immune system if it is weak the vaccine will not take. The number of small pox infected countries gradually decreased. " In April 1978, WHO ( world health organization) officials announced the world's last known case of naturally occurring small pox had been found in Somalia in October 1977" ( Fetzer 513). When small pox it the world it came down like a ton of bricks. So many people lost their lives to this horrifying disease. " Small pox was once the worst scourges ever to afflict humankind, surpassing cholera, bubonic plague, and yellow fever in time span and geographical coverage" ( Time 17). Due to the dedication of Edward Jenner and his discovery of the cowpox vaccine, many people were saved from the pains and suffering of the ugliest disease of the middle ages. This also saved many people from ding and spreading the disease to others. Now at birth people are given this vaccine along with others to stop the cathging of other diseases and to most importantly stop the spread of deadly diseases. The time period of smallpox was a bad one do to all the other terrible plagues such as the black plague, shingles, and the terrible venereal diseases of the times like oral herpes and hepatitis. There is a vaccine now for all the terrible plagues so there is nomore real concern about stuff like smallpox the big thing today is AIDS. Small pox, which was once the most feared disease known by mankind started out in the days of Christopher Columbus. The disease set out to change the lives of the people in the worse way. It became known as an epidemic disease that ended up killing hundreds of people. Small pox started out in Hispaniola and because of no cure, it traveled to the island of Puerto Rico, and then Cuba. It was only a matter of time until it spread to the mainland, somewhere in America. In the Middle Ages, small pox was a highly contagious disease which often lead to death if not treated. In this term paper you will read and learn about the causes, symptoms and treatments of this horrible disease. Small pox which was often refereed to as a life threatening disease, is caused by a virus, which was not discovered until the nineteenth century. Most of the victims whom acquired small pox, was a result of face to face contact. It is passed through the nose where tiny particles are released when the infected person sneezes, also by the mouth where particles are once again ejected when the victim coughs. The disease can be transmitted by dried small pox scabs and through materials the infected person has come in contact with. The virus is reproduced in the lymphoid tissue and released into the body. Virus reproduction begins when the virion comes into contact with a suitable host cell. The virus must interact with a receptor on the cell surface. The infectious cycle usually consists of two stages. The first stage makes the proteins necessary for the protein to form. The second stage forms the adult virion to start the attack on the body. Smallpox attack with no warning. There are several painful symptoms that are brought upon by this disease. In most of the cases, symptoms in a new victim will occur ten to twelve days later. Patients will develop chills, high fever, and nausousness. The fevers may reach up to 105 degrees farenht. In three or four days later a rash erupts and the fever and discomfort may subside. It begins on the face, then spreading to the chest, arms, back and finally the legs. It consists of hard red lumps which become pimple like, swelling and containing puss. "The pustules gave the disease its name, by which it was first known in the west as Variola" (Giblin 59). This rash itches severely but scratching must be avoided in order to prevent another infection from forming. "Up to forty percent of the patients died, in the rest, scabs eventually formed and then fell off, leaving permanent pits and scars in the skin" ( Lawrence 365). Some of the patients were also left blinded. The victims who were faced with this dreadful disease, suffered terribly. In some cases if sever enough the patient would lose the battle with smallpox and die. Sometimes the rash would never heal completely and cause an acne type look on the persons body. There is no medication to clear up the acne it is perminit, sometimes worse than others. In 1796, Edward Jenner, a British physician, developed the first vaccine to prevent small pox (Johnston 92). At the age of eight he experienced a painful fight with small pox. This was his inspiration to discover a method to prevent the suffering of small pox victims. The news of this marvelous development spread quickly and it was soon used widely around the world. During the 1800's many countries required everyone as a law, to receive the vaccine. It was recognized that the vaccine was the best quality and the disease continued to spread. The vaccination contained the virus that causes cowpox, this disease is similar to small pox but a milder form. This causes the production of antibodies that give protection against both cowpox and small pox. There is no specific treatment for small pox. Due to the disease being so contagious, patients need to be isolated until they are completely recovered. The sores must be kept clean and penicillin and sulfa medications are sometimes given to prevent further infections. However, after a person has come across the disease and recovers from it they become permanently immune to the virus. Jenner later promoted the smallpox vaccination and ultimately wiped the virus clear out. Since then there has only been one case of smallpox but they are not certain that it really was the smallpox virus or just a clone of a chicken pox virus. Vaccinations only work depending on ones immune system if it is weak the vaccine will not take. The number of small pox infected countries gradually decreased. " In April 1978, WHO ( world health organization) officials announced the world's last known case of naturally occurring small pox had been found in Somalia in October 1977" ( Fetzer 513). When small pox it f:\12000 essays\health & humanities (196)\small pox.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Small pox, which was once the most feared disease known by mankind started out in the days of Christopher Columbus. The disease set out to change the lives of the people in the worse way. It became known as an epidemic disease that ended up killing hundreds of people. Small pox started out in Hispaniola and because of no cure, it traveled to the island of Puerto Rico, and then Cuba. It was only a matter of time until it spread to the mainland, somewhere in America. In the Middle Ages, small pox was a highly contagious disease which often lead to death if not treated. In this term paper you will read and learn about the causes, symptoms and treatments of this horrible disease. Small pox which was often refereed to as a life threatening disease, is caused by a virus, which was not discovered until the nineteenth century. Most of the victims whom acquired small pox, was a result of face to face contact. It is passed through the nose where tiny particles are released when the infected person sneezes, also by the mouth where particles are once again ejected when the victim coughs. The disease can be transmitted by dried small pox scabs and through materials the infected person has come in contact with. The virus is reproduced in the lymphoid tissue and released into the body. Virus reproduction begins when the virion comes into contact with a suitable host cell. The virus must interact with a receptor on the cell surface. The infectious cycle usually consists of two stages. The first stage makes the proteins necessary for the protein to form. The second stage forms the adult virion to start the attack on the body. Smallpox attack with no warning. There are several painful symptoms that are brought upon by this disease. In most of the cases, symptoms in a new victim will occur ten to twelve days later. Patients will develop chills, high fever, and nausousness. The fevers may reach up to 105 degrees farenht. In three or four days later a rash erupts and the fever and discomfort may subside. It begins on the face, then spreading to the chest, arms, back and finally the legs. It consists of hard red lumps which become pimple like, swelling and containing puss. "The pustules gave the disease its name, by which it was first known in the west as Variola" (Giblin 59). This rash itches severely but scratching must be avoided in order to prevent another infection from forming. "Up to forty percent of the patients died, in the rest, scabs eventually formed and then fell off, leaving perma f:\12000 essays\health & humanities (196)\Smoking 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Drugs are generally recognized as of the greatest problems in the United States. According to the statistics, tobacco has the highest death rate. Smoking is a very popular habit, even though we all know that smoking is very dangerous. Millions of people around the globe want to quit smoking for medical reasons such as having already two heart-valve replacement surgeries. Wht did some people do to quit smoking? Some people substituted eating ice-cream for smoking. Why is smoking a very popular habit? The reason is you can get them anywhere. All the stores are selling cigaretes. You don't even need an identification card to identify your age if you want legal! Almost anyone can buy them! Yes, the are legal! Nowadays, even middle high school students are already smoking, and willl even lead to using drugs such as: marijuana, cocaine, and heroin. Smoking causes all sorts of cancer. It affects your brain and it do not prolong your life, not only in America, but all over the globe. Every person knows how smoking can affect our health. People know how harmful it is. They learned how harmful the cigarette from their parents, teachers, and others. Ironically, they still continue smoking! They are addicted to it, and most addicts want to be cured. f:\12000 essays\health & humanities (196)\Smoking.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Studies of ex-smokers show that their risk of dying from smoking-related disease decreases with each year of non smoking. Encouraged by such evidence, more than 40 million people in the U.S. quit smoking in the year following the 1964 surgeon general's report. The proportion of males who smoke decreased from more than 60 percent to about 25 percent; however, the percentage of women who smoke cigarettes increased. Smoking also became more prevalent among young adults, with about 29 percent of high school seniors admitting to smoking in 1975; but by 1987 this proportion decreased to 18.7 percent. There are programs that exist to help smokers quit. Some involve group support, whereas others use aversive techniques in which participants smoke many cigarettes rapidly to the point of becoming sick of them. More than 30 million persons in the U.S. say that they would like to quit smoking but cannot. One hypothesis to explain this problem is that the smoker craves the effect of the nicotine in the smoke. In a 1988 report, the surgeon general declared nicotine to be an addictive drug comparable to other addictive substances in its ability to induce dependence. The report also called the monetary and human costs far greater than those attributable to cocaine, alcohol, or heroin. Attempts to help persons quit smoking through counseling, participation in support groups, and, for those with a strong physical dependence on nicotine, substitution of chewing gum containing nicotine to lessen withdrawal symptoms. f:\12000 essays\health & humanities (196)\Steroids.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ STEROIDS "I just wanted to boost my performance." These are the words spoken by numerous athletes who have been captured using steroids. The continuous stress and pressure on athletes to perform well has caused some to breakdown and take steroids as an easy way to bulk up. Steroids amongst athletes is not the only problem. Other reasons for taking steroids may be to heal injury, improve appearance, or for various social factors. High School is definitely tough on self-esteem for teenagers who look to fit in. Many simply desire to improve their physical appearance, but they are too lazy, or do not have enough time to work out. What do they do? They resort to the use of anabolic steroids. Everyone has heard of steroids, but many people do not know exactly what they are. Natural steroids play a key role in the body processes of living things. They are naturally produced by plants and animals, and are used for various reasons. Steroids include sterols, such as cholesterol, bile acids from the liver, adrenal hormones, sex hormones, and poisons in certain toads. Sex steroids in humans give men and women the characteristics that make up the sex, such as the type of voice, and the physical build. Adrenal steroids, produced in the cortex of the adrenal gland in humans, regulate protein and carbohydrate metabolism. Aldosterone, another steroid produced in the adrenal cortex, plays a role in the mineral and water balance of the body. Anabolic steroids are commercially produced by chemical methods from the male hormone testosterone. Artificial steroids were first developed for medical purposes during World War II (1939-1945) by the German army. The Germans gave it to their soldiers to make them more aggressive in combat. After the war, doctors in Europe and the U.S. used steroids to treat anemia, malnutrition, and to help patients recover faster from surgery. Then, in the 1940s, artificial steroids began to enter the athletic world. Body builders in Eastern Europe were taking testosterone in various forms. In the 1950s, athletes used the anabolic steroids to improve their performance in international competition. With the government's approval, coaches in the Soviet Union gave the lab-produced steroids to their athletes, mainly of whom were weight-lifters and shot-putters. When other athletes around the world noticed the Soviets' winning records (Soviet weight-lifters won seven medals at the 1952 Olympics), athletes in many countries began to experiment with steroid use. In 1956, American doctor John B. Ziegler worked with a drug company to produce anabolic steroids in the United States. Soon after, American athletes, particularly football players, began using steroids as early as the 1960s. The health dangers of steroids were not yet recognized, and athletes obtained steroids legally from their team doctors. When state laws against steroid use were passed in the 1960s, a black market for the artificial testosterone quickly developed. Steroids eventually found their way into school athletics, at both the college and high school levels. During the 1980s, steroid use spread outside the athletic world. Recently the use of steroids has been increasing amongst non-athletes for various reasons. (See Chart) Due to the harmful effects of anabolic steroids, the Federal and State governments have established laws and regulations against the use of them. In 1988, Congress passed what is known as the Anti-Drug Abuse Act. This act made the distribution or possession of anabolic steroid for non-medical reasons a Federal offense. The penalty for distribution to minors is a prison offense. In 1990, Congress made the laws even stricter, and classified anabolic steroids as a controlled substance. The law also increased penalties for steroids use and shipping. To stop the selling of steroids on the black market, the law requires pharmaceutical firms to be strict with their production and record-keeping. So far, over 25 states have passed laws and regulations to control steroid abuse, and many other sates are considering similar legislation. Steroids are beneficial in many ways, but along with the good there is always a negative side. Some side effects in males include shrinking of the testicles, reduced sperm count, impotence, baldness, breast development, difficulty or pain urinating, and an enlarged prostate. In females some complications are growth of facial hair, deepened voice, breast reduction, male patterned baldness, enlargement of the clitoris, and irregular or cessation of the menstrual cycle. Growth can also be prematurely halted in adolescents, which may prove to be disastrous to their social development in later years. For more serious side effects, and how often they occur, see the graph above. $$$ PRICES OF VARIOUS TYPES OF STEROIDS $$$ STEROID QUANTITY PRICE Clomid 10 * 50 mg. $10 Cytadren 56 * 250 mg. $80 Deca Durabolin 3 * 200 mg. $50 Dianabol 100 * 5 mg. $30 Durabolin 10 ml. Multidose 100 mg. Per ml. $65 Nolvadex 30 * 20 mg. $10 Primobolan Depot per 100 mg. vial $10 PromoTeston Depot 3 * 1 ml. $30 Sustanon 250 per vial $10 Testosterone Cypionate 200 mg. $10 Winstrol (Stanozolol) 100 5 mg. tabs $30 Many people do not think about it, but steroids also have a negative effect on an addict's financial standing. Because steroids are sold on the streets and across the internet, there is a large price to pay. (See the chart above). However, people who are badly addicted are willing to pay whatever price they must to obtain the steroid. Steroids also have psychological and physiological effects on the user. Bigger muscles can help increase a persons self-esteem, but the steroids that build those muscles can lead to lowered self-esteem, depression, inability to think clearly, and a lack of energy. Scientists are just beginning to investigate the impact of anabolic steroids on the mind and behavior. Many athletes report "feeling good" about themselves while on a steroids regimen. The downside, according to Harvard researchers, is wide mood swings ranging from periods of violent, even homicidal episodes known as "roid rages," to bouts of depression when the drugs are stopped. The Harvard study also noted that anabolic steroid users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment from feelings of invincibility. After reading the facts, one must wonder, "Why would a person want to do this to themselves, especially when the negatives clearly outweigh the positives?" f:\12000 essays\health & humanities (196)\Stress in the Workplace 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ CHAPTER I INTRODUCTION Statement of the Research Problem How do you cope with stress in the workplace to achieve a more balanced lifestyle? Stress is a part of everybody's life. Depending on the level of stress, it can control our lives, especially in the workplace. We begin to spend several long hours at work, and thus have less time for other things. Stressed employees may be unhappy and thus produce nominally. Stress can deteriorate social and family relationships and eventually burn you out; ultimately it can take toll on your health. Organizations need to recognize stress as a problem and decide whether or not to act upon it. Background Information This question needs to be answered because stress is a problem that all organizations must deal with; stress can cause poor work performance and lower employee morale. These factors can increase employee turnover rate and lessen quality of life. We all must deal with stress; question is how we handle and control it. With downsizing the buzz word in the modern corporate world, companies have become mean and lean. Employees are compelled to be more efficient; they find themselves taking on the work of what used to be two. The result is longer hours, less time for outside activities, and consequently increased stress. According to Business Week, the typical American works 47 hours a week, and if current trends continue, in 20 years "the average person would be on the job 60 hours a week." Another factor that increases stress is technological advancements. With all the new technology one is always connected to work and accessible 24 hours a day 7 days a week. According to Business Week, it is now possible, and thus increasingly expected, for employees to be accessible and productive any hour, any day. At a workplace, one observes several sales people working long hours, claiming it is due to under staffing. Employees reach a point of diminishing returns. The more hours they work, the less productive they are. This stressful condition causes the quality of work to dwindle. Consequently, clients recognize this, and eventually they terminate the business relationship. Soon the company loses, as it is built on these clients. Statement of the Objectives In this research, I expect to discuss factors which lead to stress in the workplace. Are individuals stressed in the workplace? What causes stress in the workplace? Who is mostly stressed: men or women? Are individuals being exposed to stress management techniques? Should employers implement stress management techniques? As a future manager, I would like to be able to determine if stress is a problem for employees; if so, implement a strategy to curtail stress in the workplace. By recognizing stress in the workplace, employers can act appropriately to reduce stress. The outcome can benefit social and family relationships, as well as preserve ones health and make us more productive in our organizations. Scope The research project will comprise of a sample size of 30 individuals, randomly selected from general business areas. The study will analyze stress factors in the U.S workforce and its impact on the American organization. Effective stress management techniques will then be presented, which will allow individuals or organizations to implement. Secondary information from various sources will be utilized to explore effective methods of coping with stress. The conclusions and recommendations I will draw will be applicable to any American organization with stress as a problem. Although this study will generalize from the small population, it can be used as a starting point to recognizing the problem, as each organization can require a different approach. Limitations The sources utilized in the research will be extracted from current articles (1994-present) from online services, the Internet, and public libraries. A survey will be given to individuals of randomly chosen organizations and will not target any specific company or industry. Due to time constraints, the population will be limited to 30 individuals. The research will explore factors causing stress in the workplace and its impact on organizations. Effective methods of coping with stress will be given, but limited to ones examined in the secondary resources. Research Procedures The project will focus on stress factors in the workplace and effective methods to balance a healthy lifestyle. The sample group will consist of 30 individuals randomly selected from general business areas. The survey will be conducted during lunch periods when several employees leave and return to the workplace. The questionnaire will attempt to see if the sample individuals believe stress is a problem and what can be done to resolve it. The questionnaire will be delivered in person and each individual will fill out the survey at that point. Since the survey will be conducted in a general public area, no authorization is needed to administer. Once I receive all the surveys, I will quantify the data into an Excel spreadsheet. I will report the data mostly in percentages (e.g. 70percent of the individuals acknowledge that stress is a problem in the workplace). The data will be utilized to see if stress is a factor impacting the American workforce. Stress management techniques will be presented where appropriate. Additional Information Data and references will be collected between now October 12, 1996 through November 5,1996. I will conduct the survey individually. The gathering of references will also be done on my own. The study will take approximately 25-40 hours to complete, not including data collection time. CHAPTER II LITERATURE REVIEW Stress is an adaptive response. It is the body's reaction to an event that is seen as emotionally disturbing, disquieting, or threatening. When we perceive such an event, we experience what stress researchers call the fight or flight response. To prepare for fighting or fleeing, the body increases its heart rate and blood pressure; more blood is then sent to your heart and muscles, and your respiration rate increases (Domar, 1996). Stress is both positive and negative. Good stress is a balance of arousal and relaxation that helps you concentrate, focus, and achieve what you want. Bad stress is constant stress and constant arousal that may lead to high blood pressure, cardiovascular disease, and worse. The body does not distinguish between negative and positive stress. The same physiological responses can take place whether you are happy or sad about a given situation (Robinson, 1996). When extending to the workplace, stress may lead to poor work performance and end up costing an organizations several thousands of dollars. The organization loses on salary because they are not receiving satisfactory production and if the employee becomes ill, health and workers compensation rates can soar (Carpi, 1996). The organization must decide whether or no to implement a stress management program, since there are several external stressors that can overtake an individual. Internal stressors, within organizations include technology and corporate downsizing which leads to longer hours and job uncertainty. If one does not know how to manage stress, it can get out of control (Carpi, 1996). Analyzing Stress on Individuals In a 1995 survey of 1,705 respondents it is analyzed that stress rises with level of education and job level and is higher than average for women (Robinson, 1996). Fifty-eight percent of the women respondents possess moderate to a lot of stress in the workplace compared to 53 percent of men. From the divorced individuals, 62 percent are stressed in the workplace compared to married and never married at 57 percent, and 58 percent respectively. The widowed respondents maintain the least stress at 38 percent (Robinson, 1996). College graduate respondents possess more stress at 64 percent than high school graduates at 55 percent. Only 43 percent of the less than high school respondents felt stress in the workplace. Those with more education feel more stress, possibly because their jobs involve greater managerial and financial responsibility (Robinson, 1996). Stress is an epidemic in American life. In nationwide polls, 89 percent of Americans reported that they often experience high levels of stress, and 59 percent claimed that they feel great stress at least once a week (Hellmich, 1994). A five year study of the American workforce conducted by the Families and Work Institute showed that 30 percent of employees often or very often feel burned out or stressed by their jobs, 27 percent feel emotionally drained from their work, and 42 percent feel used up at the end of the work day (Hellmich, 1994). Balancing work pressures and family responsibilities leaves many workers feeling burned out. Researchers at Harvard found that as stress increases, performance and efficiency do also. However, if stress continues to increase, the level of performance and efficiency decreases (Hellmich, 1994). Paula Morrow, director of the Industrial Relations Center at Iowa State University College of Business states that According to the Center on Work & Family , "Flexible scheduling, job-sharing, and on-site child care cut absenteeism and turnover, boosting productivity. The key is for managers to give up control of the process of work and empower employees to determine how it gets done" (Daniel, 1994). Examining the Effects of Downsizing on Stress The downsizing of organizations have caused a stressful environment. Downsizing has created concerns over job security, and has forced employees to take on a larger workload. According to a local union representing U.S. West stated that work still needs to be done, but with fewer people (Scott, 1996). Downsizing creates quantitative and qualitative stress. Quantitative stress pertains to doing the same amount of work with fewer people. Reengineering the organization entails shaping the company to be more efficient with less individuals. These individuals are asked to do a wider variety of work functions they are not trained to do, causing qualitative overload (Scott, 1996). Identifying Job Uncertainty Elizabeth Fried, president of N.E. Fried and Associates states, "We have cut out a whole layer of middle management an the pressure has to go someplace, either up or down." (Tahmincioglu, 1995) Ed Simon, analyst with the Labor Department is concerned that the "leaner, meaner" mentality will be a trend that continues with us for a while. He states that eventually the people working long hours may not be able to keep that pace up and that it might be to a company's benefit to train and bring in more workers (Tahmincioglu, 1995). Not only are the longer hou f:\12000 essays\health & humanities (196)\STRESS IN THE WORKPLACE.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ COPING WITH STRESS IN AN ORGANIZATION 26 November 1994 Table of Contents I. Introduction II. Defining Stress III. Types of Stress IV. How to Handle Stress V. Recognizing Stress VI. The Military and Stress VII. Summary COPING WITH STRESS IN AN ORGANIZATION I. INTRODUCTION Since the beginning of mankind there has always been some kind of stress affecting how people feel, act and cope with situations. In this paper we will look at the definition of stress and what causes people to have stress. Then we will see how different people handle stress and show how not all individuals have the same tolerance for stress. The next thing that will be discussed is how managers in organizations can recognize and reduce the negative effects that stress has on the worker and the organization. Finally we will consider what kind of stresses there are in military organizations and how they can be controlled. II. DEFINING STRESS Robert C. Dailey, in his book Understanding People In Organizations, defines stress as "any demand made on the body that requires psychological or physical adjustment." Many people think of stress as always being something bad. However, stress sometimes can be good. Stress is part of our every day life. It can have a motivating effect or a demotivating effect. Each of us have our own level of how much stimulation or stress we need in our lives to keep us from getting bored.1 Others however, have a much lower tolerance for stress stimuli. So managers must be able to look at each individual and decide if the individual has a high or low tolerance for stress. Managers can do this only if they have a good understanding of what causes stress. III. TYPES OF STRESS Stress can come from a multitude of different reasons, but for simplicity lets break it down into two forms: individual induced stress and physical environment stress. Individual stress includes things such as role conflict, role ambiguity, work overload, and responsibility for others. Role conflict occurs when accomplishing one job inhibits or greatly reduces the chance at completing another assigned task. In this case the person who is tasked to do the jobs will incur some type of stress while trying to figure out how to get both tasks accomplished in the given amount of time. How much stress and if it will impact the individual positively or negatively will depend on the experience level of the individual. Role ambiguity is when an individual is not sure of what their job entails. It makes it hard for a person to decide on what their priorities are and how to manage their time. Ambiguity can come from a number of different things. A transfer, promotion, new boss, or new co-workers can all cause an individual to experience some type of role ambiguity and added stress. Both role conflict and role ambiguity relate to job dissatisfaction, lower level of self-confidence, and sometimes elevated blood pressures.2 When these occur an individual's motivation decreases, family problems surface, and depression sets in. Another form of individual induced stress is work overload. There are two forms of work overload: quantitative and qualitative. Quantitative occurs when a person has too many things to accomplish and not enough time to do them in. Qualitative overload on the other hand is when the individual doesn't have enough experience or expertise to accomplish the task(s) at hand. Both of these type of stressors are very detrimental to an individual's health. In fact because employees feel as if they are doing two or more jobs at once and have no time to themselves they experience elevated cholesterol, blood pressure, and pulse rate.3 Another factor which affects employees is when they have or feel they have the responsibility for other co-workers. This can happen not only to managers but also to other employees who may be group leaders or even union leader. When you start adding up all of these individual responsibilities the potential for employees having some sort of job related stress is very high. Now lets move on to physical work environment stressors. When people think of physical work environment they usually think of some type of hard labor. But its not confined only to physical labor, it also encompasses other factors such as noise, temperature, lighting, and pollution.4 So that means even people in business and people in construction both have some kind of physical work environment stressors. Stress from noise doesn't have to be caused from loud sounds. It could be the sound of the air conditioner or maybe even the silence of some one who is sitting next to you and you know they are watching what you do. Temperature also adds to frustration and therefore causes stress. Whether its from working out in the blazing sun or from sitting beside the air conditioner, they both can lead to stressful situations. Light can cause stress because of being to high, to low, or the wrong type. Any of these can make a person strain their eyes thus make them more susceptible to stress. When you put all the individual and physical stressors together you can see why job stress is drawing more and more attention. IV. HOW TO HANDLE STRESS Although every person handles stress in their own particular way they all basically go through the same stages. Professor Hans Selye called these stages the 'general adaptation syndrome'.5 He says that the body adjust to stress in three stages; (1) alarm reaction, (2) adaptation, and (3) exhaustion. Alarm reaction is where a person first becomes aware of whatever the stressor is. In this stage the body activates its defensives. Some of the notable traits are higher blood pressure, rapid breathing, faster heart rate, and muscle tension. In the adaptation stage the body tries to identify which system it needs to use to deal with the long term effect of what ever is causing stress. Then the body moves into the exhaustion stage. This is where the body is totally depleted of its adaptive energy. The body also can revert back to the symptoms of the alarm reaction stage.6 From having a basic understanding of how a person's body reacts to stress, managers have a better insight on what to look for when trying to figure out what the limits are of their personnel. V. RECOGNIZING STRESS The best way to learn how to notice signs of stress in other people is to become aware of your own types of symptoms. There are many warning signs available to us. A few of them include dryness of the mouth, insomnia, chest pain with no known cause, rapid breathing, stomach pain, and changes in appetite. When you feel these type of symptoms pay attention to how you react to them. More than likely what you do will probably be the same way others cope with stress. Here are some of the things you might not see in your self that you might notice in your co-workers; drug use, excessive drinking, absenteeism, and emotional outbursts. One of the more serious stress-related sickness is depression. This happens when a person loses their self-esteem and they feel that they have no control over their job. Two signs associated with depression are the inability to meet deadlines and having trouble making decisions while at the same time worrying about both of them excessively.7 Managers need to be able to recognize these signs of stress in the work place so productivity won't be hurt and the quality of life for the employees remain high. What exactly can be done about stress? The most important thing that organizations can do is try to keep stress at a minimum on the job. Employers need to make sure that they educate their employees about how to handle stress. This can be in done at a formal meeting, at informal group meetings, or by newsletter. The main thing is to get the word out about stress and heighten individuals awareness of it. There are many avenues to take that help relieve stress. Physical fitness, nutrition, weight loss, and smoking programs are some of the more popular ways to help ward off stress. One way that employers are responding to employees' emotional, physical, and personal problems are employee assistance programs(EAP).8 These programs are set up by the employer with a local medical organization that has the capability of helping employees that have some type of problem whether it be drug dependency, alcoholism or smoking. The employer in these programs pay for part or all the expenses of the program. Another way organizations are helping their employees to deal with stress are wellness programs. Many organizations are using these programs and are reporting great results from them. Companies are beginning to realize that programs dealing with stress-related problems before they become chronic can be a major contributor to the quality of work life for employees thus enhancing their job performance.9 Some companies spend millions of dollars each year on wellness programs. One company even paid their employees bonus' for any weight they lost. Although these programs sound like they cost a lot they actually save companies money in the long run. This is because of several factors some of which are less hospital stays, less health insurance claims, reduced accidents rates, and increased employee satisfaction. All of these lead to a more productive individual and better work force. One other aspect of reducing stress deals with specific behavioral techniques for mental relaxation. These are brought out in stress management courses that some companies let their employees attend. They focus their attention on the concept that the central nervous system can't differentiate between a real experience and an imagined experience. These classes teach things like deep breathing, muscle relaxation, biofeedback, and how stress can affect them personally and what they can do about it.10 In today's society where pressures are becoming more and more extreme organizations, leaders, and managers need to be aware of the stress that their work force encounters and set up some type of program to help them deal with them. In the military there are the same type of stressors as in the private sector and also a few that wouldn't be found in corporate industries. Military leaders must look at their personnel and see what kind of pressure they are experiencing to be effective leaders. In fact they need to be even more vigilant for signs of stress because they must be sure that an individual is ready to go to combat, both in a physical and mental state, at a moments notice. VI. THE MILITARY AND STRESS There are many things that can cause undo stress in the military. They range from worrying about getting promoted to getting a college education and to trials and tribulations of being separated from ones' family for long periods of time. Some of the things already mentioned before such as responsibility for others, role conflict, and role ambiguity are all present in the military work force. Stress affects enlisted personnel as well as officers. Lets explore some of the ways the military and military leaders can help the organization and its members to cope with stress and its effects. One way the armed forces has dealt with stress in its organization is with EAPs.11 Almost all bases have some type of program to help members who have some type of dependency. The first step however is usually the hardest, is to identify the people who need the help. Most of the programs allow the member to volunteer for help without retribution. Individual commanders also can play a big part in helping members find help. By making sure their troops know about what programs are available and by having stress awareness training so other members know what to look for in their co-workers, the commander is able to stop chronic stress before it occurs. Another way the services deal with preventing stress are their physical fitness programs. Each unit should support these programs by assuring the individuals have time allotted to participate in them. Still another way that has picked up steam in the last couple of years is the quality of life working teams. These teams look for ways to improve the quality of living both during work hours and after. So as you can see the military is concerned about stress and are taking great steps in trying to reduce its affects. VII. SUMMARY We have taken a look at what the definition of stress and some of the causes of stress in the work place. It is important to try and reduce these causes as much as possible so that employees won't get any stress related symptoms. Also it was stated how a persons' body reacts when it encounters stress. Then the signs of stress that managers need to look for were discussed. After that some of the ways organizations can help it employees manage stress were looked at. Finally, it was shown how the military is handling stress among its members. As the world gets more diverse stress in the work force will continue to grow. It is imperative for managers and leaders to be able to recognize stress, understand its causes, and know how to alleviate it in their organizations so that it can continue to grow and be productive. f:\12000 essays\health & humanities (196)\SUICIDE 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ (, 1) Suicide is intentional self-inflicted acts that end in death("Suicide," Compton's). After a series of traumatic events, normal coping abilities can be pushed over the edge; the result may be suicide. In each year, an average of 30,000 suicide deaths occur in the United States. It is estimated that 5,000 of those suicides are committed by teenagers(SA\VE, 2). One major reason that the suicide rate among teenagers is so high, is that the teenage years are a period of commotion. New social roles are being learned, new relationships are being developed, bodily changes are occurring, and decisions about the future are being made during the teenage years. Teenagers tend to commit suicide after large changes, significant losses, or abuse has occurred in their lives. An important change in a relationship, school or body image may contribute to a teenagers' tendency to commit suicide. The death of a loved one, the loss of a valued relationship, and the loss of self esteem are some significant losses which might be a factor in teen suicide("The Real World [Suicide: Facts]," 1). Perceived abuse such as physical, emotional, psychological, sexual, social abuse or neglect can lead to self-murder("Teen Suicide," 3). Significant changes, losses, and abuse can promote suicidal tendencies. Few suicidal people have some type of depression, yet those who have one can be provoked to commit suicide. There are two main types of depression suffered by (, 2) suicidal people("Suicide," {Grolier}). The first type is reactive depression. This type of depression is the reaction of a difficult and often traumatic experience. Endogenous depression is the second type of depression. It is the result of a mental illness which is diagnosable by a professional. Some suicidal people have a combination of both reactive depression and endogenous depression. Others could have a depression which is undiagnosed. A persistent sad mood, thoughts of suicide, persistent physical pains that do not respond to treatment, difficulty concentrating, irritability and fatigue are some symptoms of depression(American Psychiatric Association, 4). If a person has four or more of the symptoms lasting for more than two weeks, that person could have a type of depression. Those people with mental illnesses such as schizophrenia and clinical depression have much higher suicide rates than average(Tom Arsenault, 2). Teenagers display warning signs of suicide. The indications come in two ways. First exhibited are the early warning signs. These signs include difficulties in school, depression, drug abuse, sleep and eating disturbances, and a loss of interest in activities. Restlessness, feelings of failure, overreaction to criticism, overly self-critical, anger, and a preoccupation with death or Satan are also some signals teenagers contemplating suicide will give("Teen Suicide," (, 3) 3). The other type of clues are late warning signs. Talking about death, neglecting appearance, a feeling of hopelessness, a sudden improvement in personality, and giving away possessions are some of the typical late warning signs given by a suicidal teenager("Teen Suicide," 4). Not everyone who portrays these symptoms is suicidal. In order to know if a person is really thinking about committing suicide, someone needs to ask them. Offering other ways to deal with a suicidal persons' problems, may save their life. Most teenagers contemplating suicide would not commit it, if they knew of another way out. By talking with someone who is suicidal, that person might see that there are people who love them. Despite the efforts of people to stop a teenager from committing suicide, some succeed. The statistics of considered and completed suicide are shocking. Ten percent of teenage boys admit that they have attempted suicide. Girls in their teens have a much higher percentage(eighteen percent), which will admit that they unsuccessfully tried to commit suicide. A teenager in 1990 was twice as likely to die from suicide than a teenager growing up in 1960. One of the most startling teenage suicide facts is that since 1961, there has been a tripling of completed teenage suicide("The Real World [Suicide: Facts]," 1-3). When a teenager is able to successfully commit suicide, they leave behind family and friends. In a (, 4) normal death situation, people usually feel grief. When a teenager performs suicide, family and friends left behind experience many feelings. A feeling of confusion and great distress over unresolved issues is very common. Family members and friends often feel anger and resentment after a suicide. These emotions can cause friends and family to become very isolated feeling. A friend or family member may find that it is difficult to relate to other people after a suicide. These people may decide that other people view them as a failure because they were unable to stop someone close to them from committing suicide. A fear of forming new relationships after a person has completed suicide is common. People feel that by creating new relationships, they might be hurt and experience the same pain they are going through. In order to help people who have experienced the suicide of someone they deeply cared about, "survivor groups" have been created ("Suicide-Frequently Asked Questions," 6). Knowing they will be accepted without being judged or condemned, helps a person go to a "survivor group." At a meeting, the people's intense burden of unresolved feelings may be lessened. Suicide is the third leading killer among teenagers(SA\VE-Suicide Awareness\Voices of Education, 6). Suicide can be committed for a number of reasons. Anyone who talks about suicide, should be taken to see a professional. The most important way to prevent suicide (, 5) is to talk. (, 6) WORKS CITED American Psychiatric Association. "Teen Suicide." APA Joint Commission on Public Affairs and the Division of Public Affairs. 1988. Pages 1-5. Arsenault, Tom. "Did You Know?" http://www.save.org/ index.html//save@winternet.com. 1996. Pages 1-4. "The Real World [Suicide: Facts]." http://www.paranois. com/%7Ereal/suicide/facts.html. 1996. Pages 1-3. SA\VE-Suicide Awareness\Voices of Education. http://www. save.org. 1996. Pages 1-6. "Suicide." Compton's Interactive Encyclopedia. Compton's NewMedia, Inc. 1994. "Suicide-Frequently Asked Questions." Oxford University Libraries Automation Service. http://www.lib.ox. ac.uk/internet/news/faq/archive/suicide.info.html. 19 July 1996. Pages 1-8. "Suicide." Grolier Electronic Encyclopedia. Grolier Electronic Publishing, Inc. 1995. "Teen Suicide." American Academy of Child and Adolescent Psychiatry. 1996. Pages 1-5. Teenage Suicide Psychology 100 December 19, 1996 f:\12000 essays\health & humanities (196)\suicide.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ SUICIDE The natural end of every human life is death. Some people, for reasons that have never been fully understood, choose to end their own lives. This is called suicide, which means literally "self-killing." For all the uncertainty that has surrounded the phenomenon of suicide, his assessment of the problem is probably as accurate as any. The individual, in seemingly hopeless conflict with the world, decides to end his or her existence in what amounts to a final assault against a society that can no longer be tolerated. In so doing, the person tries to obtain a final revenge on everything and everyone that have caused their feelings of depression. Sometimes suicide has been used as a form of execution. Perhaps the most famous such case is that of the philosopher Socrates, who was required to drink hemlock to end his life in 399 BC, after being found guilty of corrupting the youth of Athens. In the 20th century the German general Erwin Rommel took poison rather than be executed for his role in a plot to oust Adolf Hitler from office. In some societies suicide has had social ties. In Japan, for example, the customs and rules of one's class have demanded suicide under certain circumstances. Called seppuku or popularly known as hara-kiri, which means "self- disembowelment" it has long been viewed as an honorable method of taking one's life. It was used by warriors after losing a battle to avoid the dishonor of defeat. Seppuku was also used as a means of capital punishment to spare warriors the disgrace of execution. In India, widows allowed themselves to be burned to death on their husband's funeral pyre, a practice called suttee. At least since the 18th century, suicide has been thought of by some as a romantic type of death. This notion led to the belief that some artistic individuals writers, painters, and poets glamorize suicide, thinking that such a death will add to their reputations. The German writer Johann Wolfgang von Goethe's novel 'The Sorrows of Werther' (1774) reinforced this concept and was credited with causing a large number of romantic suicides in Europe. Among well- known artists who killed themselves are Vincent van Gogh, Virginia Woolf, Anne Sexton, Mark Rothko, Jerzy Kosinski, Ernest Hemingway, and Sylvia Plath. Most suicides in the 20th century occur when the bonds between an individual and society are injured or broken. Some event, or combination of events, puts the person "over the edge". Loss of a job or the death of a friend or relative can start the thoughts of suicide. At the start of the Great Depression, for example, many people who had suddenly lost great wealth killed themselves. The emotions springing from unfavorable events are hostility, despair, shame, guilt, despondency, and alienation. Focusing on the negative occurences is what casues the person to commit suicide. The increase in teenage suicides during the 1980s probably resulted from an element of romantic fantasy combined with hostility toward the immediate world. Many suicides result from loss of boyfriend/girlfriend and from loneliness. Closely related to these emotions is the conviction that the happiness of past years can never be recaptured. Sometimes, terminally ill persons choose to end their lives rather than submit to long, painful declines. In the early 1990s the controversial topic of assisted suicide in which terminally ill people are aided in committing suicide by physicians, loved ones, or other acquaintances was examined as a legal topic. However, voters in Washington state in 1991 rejected a proposition to legalize physician-assisted suicide. Nevertheless, Derek Humphry's book "Final Exit", a guide for terminally ill people who want to commit suicide, became a best-seller that same year. During wartime, suicide rates drop dramatically. This decline may be related to the turning of aggression toward a common enemy, suggesting that there may be a great deal of agression that is not known behind the act of suicide. Judaism, Christianity, and Islam have all condemned suicide as a violation of the law of God. In Europe religious and civil laws were used to combat suicide from the early Middle Ages until the 19th century. After the French Revolution (1789) criminal penalties for attempting suicide were abolished in European countries. Great Britain was the last to abolish its penalties, in 1961. Prevention of suicide has proved difficult unless an individual demonstrates warning signs. Early recognition and treatment of mental disorders are possible solutions. Since the 1950s suicide-prevention centers have been set up in many countries. They maintain telephone hot lines that desperate or lonely individuals may use to get help. City dwellers are far more likely to commit suicide than rural people. Laborers are much less likely to commit suicide than business and professional men. Throughout the world, three or four times as many men as women kill themselves. Male suicides generally hang themselves, or use a knife or a gun. Women often choose poisoning or drug overdose as means of death. Studies have shown that married men and women are less likely to commit suicide. Year after year, the number has increased during the late spring and early summer. f:\12000 essays\health & humanities (196)\Superdad Syndrome.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ A long time ago, way back in the 1950's, there was a cold, icy creature known as the "fifties father." He rarely displayed affection, and he hid most of his feelings behind the newspaper. Most of the child-rearing duties were left to mom. We can kiss those days good-bye! In Western cultures there is an increasing number of men who are extremely active in all stages of raising their children. The old "fifties father" is now becoming the "nineties nanny." These modern "superdads", as we call them, have to manage the tough job of raising children and supporting them financially. Men have to fo this without the help of a previous role model in a past generation to model themselves after. Not having a role model makes being a superdad tougher than being a single mom. It leads to the creation of a "superdad syndrome." Superdad syndrome stems from the fact that boys growing up have very little practice at homemaking. Boys who play with dolls are considered weirdos while girls who play with dolls and participate in sports are trained for anything. Men can do a great job raising their children and providing basic needs, support, and love, but a man can never be a mother. A good example of this is Joel Chaken from New York City. He quit his job as an engineer to stay at home with his baby. His wife was an attorney. After a while he felt isolated at home all the time, and ne wanted to join a support group for new mothers who felt the same way. He was kicked out because he was not a mom, he was a superdad. Men need support groups of their own, for fathers. Even though there is an increasing number of dads taking care of their children, the court system rarely gives full custody to fathers. When superdads get custody of their children, they find it very rewarding to get closer to their kids. They also feel a sense of nobility. Many people look at single fathers with greater respect than single mothers. Fathers are seen as "superheroes." One such superhero dad is Rudy Szabo of Cleveland, Ohio. When his wife left, he quit his job as supervisor ar BEK Industries to stay at home with his two sets of young twins. He changed 72 diapers and mixed 30 bottles of formula every day, all while getting by on $500 per month. Rudy truly classifies as a superdad according to psychologist Stuart Fischoff. He says, "Superdads are men who sacrifice and structure their lives around parenting." More and more, now numbering nearly 250,000, superdads are making these changes and sacrifices. They are learning every day and doing it all on their own. f:\12000 essays\health & humanities (196)\teen smoking.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Cause and effect En 101 05 October 30, 1996 Teen Smoking Due to peer pressure, propaganda and availability, teenage smoking has been on the rise since 1986. Three thousand children start using tobacco each day because of the negative influences aimed toward them. Our President and the American Medical Association have taken action and have urged tobacco companies to do the same against under age smoking. Despite all positive actions against it, "pack-a-day" smoking has risen thirty-three Percent in the past ten years among high school seniors. Throughout life children and adults are being persuaded to do or try something that goes against what they believe. Peer pressure is common place in grade school, where children are constantly being exposed to smoking. Cigarettes are being smoked everywhere authority is not, during school or any other place kids congregate. Kids smoke because they want to feel like they 'fit in' and they want to rebel at the same time. "U.S. News discussed the smoking issue with twenty teenagers from suburban Baltimore. Half were boys, half girls, and all were between the ages of fifteen and seventeen. Over more than four hours of conversation, it became clear that most teens smoked for two seemingly contradictory reasons: They want to be part of a peer group, while rejecting society and its norms. They want to reach out and rebel at the same time."(Roberts 38) Tobacco companies spend four billion dollars each year in advertising and promotional costs and claim there is no health risk. Six hundred thousand people die every year from smoking related illness, and others quit. Teenagers are not concerned about their health. The tobacco industry tries to appeal to the youth. The earlier kids get hooked, the more secure the companies' sales are. "For the tobacco industry, these youngsters are an essential source of new customers. While cigarette makers deny it, advertising and promotion of youthful smoking clearly helped attract the attention of teens. The rate of youthful smoking dropped steadily from 1976 until 1984, then leveled off--just as cigarette companies boosted promotional budgets."(Roberts 38) Availability of cigarettes for minors is easier than one might think. Children have access to tobacco products many ways. They could steal them from their parent or relative, and from a store. Their family might also give them cigarettes, and the child smokes them with their friends. Kids can purchase smokes from an unguarded vending machine or gas station with ease. If that does not work they can ask someone old enough to buy packs for them. Although, it is just as easy to walk into any store and ask for them. Convenience stores are constantly getting fined for the underage sale of tobacco. If laws were more strict on the sale of tobacco to minors, then kids would smoke less. The harder it is to get cigarettes, the less they will smoke them. It is clear from the surveys and articles published that teen smoking is on the rise. Teenage smoking is escalating at the rate of one million new recruits a year. Despite the work of governmental and independent agencies the tobacco industries continue to sell cigarettes at an alarming rate, due to peer pressure propaganda and availability of the product. Something must be done to make people aware of the risks. Cause and effect En 101 05 October 30, 1996 Teen Smoking Due to peer pressure, propaganda and availability, teenage smoking has been on the rise since 1986. Three thousand children start using tobacco each day because of the negative influences aimed toward them. Our President and the American Medical Association have taken action and have urged tobacco companies to do the same against under age smoking. Despite all positive actions against it, "pack-a-day" smoking has risen thirty-three Percent in the past ten years among high school seniors. Throughout life children and adults are being persuaded to do or try something that goes against what they believe. Peer pressure is common place in grade school, where children are constantly being exposed to smoking. Cigarettes are being smoked everywhere authority is not, during school or any other place kids congregate. Kids smoke because they want to feel like they 'fit in' and they want to rebel at the same time. "U.S. News discussed the smoking issue with twenty teenagers from suburban Baltimore. Half were boys, half girls, and all were between the ages of fifteen and seventeen. Over more than four hours of conversation, it became clear that most teens smoked for two seemingly contradictory reasons: They want to be part of a peer group, while rejecting society and its norms. They want to reach out and rebel at the same time."(Roberts 38) Tobacco companies spend four billion dollars each year in advertising and promotional costs and claim there is no health risk. Six hundred thousand people die every year from smoking related illness, and others quit. Teenagers are not concerned about their health. The tobacco industry tries to appeal to the youth. The earlier kids get hooked, the more secure the companies' sales are. "For the tobacco industry, these youngsters are an essential source of new customers. While cigarette makers deny it, advertising and promotion of youthful smoking clearly helped attract the attention of teens. The rate of youthful smoking dropped steadily from 1976 until 1984, then leveled off--just as cigarette companies boosted promotional budgets."(Roberts 38) Availability of cigarettes for minors is easier than one might think. Children have access to tobacco products many ways. They could steal them from their parent or relative, and from a store. Their family might also give them cigarettes, and the child smokes them with their friends. Kids can purchase smokes from an unguarded vending machine or gas station with ease. If that does not work they can ask someone old enough to buy packs for them. Although, it is just as easy to walk into any store and ask for them. Convenience stores are constantly getting fined for the underage sale of tobacco. If laws were more strict on the sale of tobacco to minors, then kids would smoke less. The harder it is to get cigarettes, the less they will smoke them. It is clear from the surveys and articles published that teen smoking is on the rise. Teenage smoking is escalating at the rate of one million new recruits a year. Despite the work of governmental and independent agencies the tobacco industries continue to sell cigarettes at an alarming rate, due to peer pressure propaganda and availability of the product. Something must be done to make people aware of the risks. Cause and effect En 101 05 October 30, 1996 Teen Smoking Due to peer pressure, propaganda and availability, teenage smoking has been on the rise since 1986. Three thousand children start using tobacco each day because of the negative influences aimed toward them. Our President and the American Medical Association have taken action and have urged tobacco companies to do the same against under age smoking. Despite all positive actions against it, "pack-a-day" smoking has risen thirty-three Percent in the past ten years among high school seniors. Throughout life children and adults are being persuaded to do or try something that goes against what they believe. Peer pressure is common place in grade school, where children are constantly being exposed to smoking. Cigarettes are being smoked everywhere authority is not, during school or any other place kids congregate. Kids smoke because they want to feel like they 'fit in' and they want to rebel at the same time. "U.S. News discussed the smoking issue with twenty teenagers from suburban Baltimore. Half were boys, half girls, and all were between the ages of fifteen and seventeen. Over more than four hours of conversation, it became clear that most teens smoked for two seemingly contradictory reasons: They want to be part of a peer group, while rejecting society and its norms. They want to reach out and rebel at the same time."(Roberts 38) Tobacco companies spend four billion dollars each year in advertising and promotional costs and claim there is no health risk. Six hundred thousand people die every year from smoking related illness, and others quit. Teenagers are not concerned about their health. The tobacco industry tries to appeal to the youth. The earlier kids get hooked, the more secure the companies' sales are. "For the tobacco industry, these youngsters are an essential source of new customers. While cigarette makers deny it, advertising and promotion of youthful smoking clearly helped attract the attention of teens. The rate of youthful smoking dropped steadily from 1976 until 1984, then leveled off--just as cigarette companies boosted promotional budgets."(Roberts 38) Availability of cigarettes for minors is easier than one might think. Children have access to tobacco products many ways. They could steal them from their parent or relative, and from a store. Their family might also give them cigarettes, and the child smokes them with their friends. Kids can purchase smokes from an unguarded vending machine or gas station with ease. If that does not work they can ask someone old enough to buy packs for them. Although, it is just as easy to walk into any store and ask for them. Convenience stores are constantly getting fined for the underage sale of tobacco. If laws were more strict on the sale of tobacco to minors, then kids would smoke less. The harder it is to get cigarettes, the less they will smoke them. It is clear from the surveys and articles published that teen smoking is on the rise. Teenage smoking is escalating at the rate of one million new recruits a year. Despite the work of governmental and independent agencies the tobacco industries continue to sell cigarettes at an alarming rate, due to peer pressure propaganda and availability of the product. Something must be done to make people aware of the risks. Cause and effect En 101 05 October 30, 1996 Teen Smoking Due to peer pressure, propaganda and availability, teenage smoking has been on the rise since 1986. Three thousand children start using tobacco each day because of the negative influences aimed toward them. Our President and the American Medical Association have taken action and have urged tobacco companies to do the same against under age smoking. Despite all positive actions against it, "pack-a-day" smoking has risen thirty-three Percent in the past ten years among high school seniors. Throughout life children and adults are being persuaded to do or try something that goes against f:\12000 essays\health & humanities (196)\Teens and Ciggerette Smoking.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Abstract Cigarette smoking is of interest to the National Institute on Drug Abuse both because of the public health problems associated with this form of substance abuse and because this behavior represents a prototypic dependence process. In the past few years the government has made every effort to reach the masses, in an attempt to curb the exploitation of tobbacco use, and its acceptance among Americas Youngsters. However, cigarette smoking among adolescents is on the rise. The premise that the behavior of adolescents is influenced by the behavior of their parents is central to many considerations of health and social behavior (Ausubel, Montemayor, & Svajiian, 1977; Bandura & Walters, 1963). Many young people between 10-18 years of age experiment with smoking, smoking is a personal choice, and usually exploratory in nature. Typically, it takes place in rather young people and is largely dependent on: first, the availability of opportunity to engage in the behavior, second, having a fairly high degree of curiosity about the effects of the behavior; third, in finding it a way of expressing either conformity to the behavior or others (such as parents, older siblings or peers), forth, as in "Miller and Dollar's" explanation of Observational Learning, The Copying behavior effect. This research is to examine the effects of parental smoking (behavior), has, on the decision of teens to smoke cigarettes. Due to prior studies using global measures that may or may not include South Eastern North Carolina. The Fayetteville/Fort Bragg area was chosen for this study to pinpoint the effects in this particular locale. Fort Bragg and Pope Air Force Base have a very diverse socieo-economic and culturally diverse population, which will have a positive effect on randomness of sample selection. With this association in mind, this researcher is interested in knowing if there is a relationship of Parental influence on Teen Smoking within this Military Community. Introduction The prevalence of cigarette smoking among young teenagers is a growing problem in the United States, many young people between the ages of 10-18 are experimenting with tobacco. During the 1040's and 50's smoking was popular and socially acceptable. Movie stars, sports heroes, and celebrities appeared in cigarette advertisements that promoted and heavily influenced teens. Influence also came from Television and other media sources. The desires to be accepted and to feel grown up are among the most common reasons to start smoking. Yet, even though teenagers sometimes smoke to gain independence, and to be part of the crowd parental influence plays the strongest role as to whether or their children will smoke, Journal of American Medical Association (JAMA), 1991. Children are exposed to and influenced by the parents, siblings, and the media long before peer pressure will become a factor. Mothers should not smoke during pregnancy, nicotine, which crosses the placental barrier, may affect the female fetus during an important period of development so as to predispose the brain to the addictive influence of nicotine. Prenatal exposure to smoking has previously been linked with impairments in memory, learning, cognition, and perception in the growing child. (National Institute of Drug Abuse, 1995) Subsequent follow-up after 12 years suggest that regardless of the amount or duration of current or past maternal smoking, the strongest correlation between maternal smoking and a daughter's smoking occurred when the mother smoked during pregnancy. NIDA also reported that of 192 mothers and their first born adolescents with a mean age of 12 1/2, the analysis revealed that 26.6% of the girls whose mother smoked while pregnant had smoked in the past year. The 1991 smoking prevalence estimate of 25.7% is virtually no different from the previous year's estimate of 25.5%. If current trends persist, we will not meet one of the nation's health objectives, particularly a smoking prevalence of no more than 15% by the year 2000. When comparing the use of alcohol, cigarettes, and other drugs, only cigarette use did not decline substantially among high school senior among 1981 to 1991. In contrast studies performed by "household survey" by the NIDA and the CDC, (Centers for Disease Control) in 1991 and 92 respectively, suggested that the strongest influence on teenage smoking is parents. Research also revealed that approximately three fourths of adult regular smokers smoke their first cigarette before the age of 18. This data was acquired while trying to determine the brand preferences of young smokers to determine what encouraged them to smoke and to suggest smoking prevention or smoking cessation strategies, the studies found that in over 80% of the households surveyed, one or both parents smoked. Many teenagers begin smoking to feel grow-up. However, if they are still smoking when they reach 30, the reason is no longer to feel like an adult; at this point, they are smoking from habit. Goodwin, D. W., Guze, S. B. (1984). Young children who see older children or family members smoking cigarettes are going to equate smoking with being grown up. Patterns of both drinking and smoking, which are closely associated, are strongly influenced by the lifestyles of family members peers and by the environments in which they live. Minimal, moderate, and heavy levels of drinking, smoking, and drug use, among family members are strongly associated with very similar patterns of use among adolescents. Bentler, P., Newcoomb, M., (1989). Parents who smoke and wish they didn't should concentrate on their own efforts to stop and hope that their offspring get the message. Another good view of smoking among young people can be obtained from the federal government's Annual National Survey of drug use among seniors, and now other high school students. Reports of cigarette use in the past years have declined since the peak of almost 40% in 1975. The 30% mark was crossed in 1981, with a very gradual further decline to 25.7% in 1991 and increased to 27.8% in 1992, Johnston, O'Malley, (1993). According to cognitive social learning theory, boys and girls learn appropriate behavior through reinforcement and modeling. To date, numerous studies have examined parental influence on teenage smoking and has yielded equivocal results Due to the implications of cigarette smoking behavior for the public health and the view that smoking is the prototypical dependence process. Research taken from the TAPS (Teen-age Attitudes and practices Survey) 1992, reported that if parents smoke, their children are more likely to smoke. In regions of the United States that was surveyed, it was documented that 9135 of 11609 (79%), of the respondents to the survey of teenage smokers lived in households where one or both parents/guardians smoked tobacco. This information was taken from household samples of adolescents ages 12-18 done by a computer Assisted Telephone interviewing system (CAT). The goal of this research is to focus upon the systematic compilation of data collected in this survey/correlation study and serve as a basis for designing feasible and effective treatment strategies as well as enhance our understanding of dependence associated with cigarette smoking and substance abuse. Method Design Questions will be of nominal and rating format (attached), Non respondents will not be included in the study. The questions (10), will be on a 8 1/2x 11 sheet of paper. The questions will be divided into three categories, (health history of parents present smoking habits, and general. The Dependent variable used in this study is adolescent smoking behavior. Subjects A total of 500 teens male and female 14-18 years old, randomly selected from various areas around the Fort Bragg, Pope Air Force Base, and Fayetteville area. $2 will be given in exchange for participation. Materials Questionnaires will be given to individuals upon their approval to participate in the study, a number two pencil will be used to write with. Procedure Participants will be chosen at random from either the Post Exchange and the movie theaters of the Fort Bragg area. Participation will be voluntary after an explanation of the study. Since this research involve minors, each participants will sign a release form. Each respondent will be allotted 15 minutes to complete the questionnaire, and not to discuss the contents with other participants. However participants, will be told that they can discuss this issue with parents/guardians. A phone number of the researcher will be given to each respondent in case of any afterthoughts. Non respondents will not be included in the study. The questions (10), will be on a 8 1/2x 11 sheet of paper and consist of both, true/false, and nominal data, yes/no. The questions will be divided into three categories, (health history of parents present smoking habits, and general. chi- square and t-distribution statistics will be used to identify significant differences between sub samples. References Bauman, K. E., Foshee, V. A., Linzer, M. A., Koch, G. G. (1990). Effect of parental smoking classification on the association between parental and adolescent smoking. Addictive-behaviors, 15,(5), 413-422. Horevitz, M. J., (1985). Disasters and psychological responses to stress. Psychiatric Annals, 15, 161-167. Hu, F. B. Flak, B. R., Hedeker, D. (1995). The inlf\uence of friends and parental smoking on adolescent smoking behavior. Journal of Applied Social Psychology, v4 (3), 215-225. Jessor, R. (1993). Successful adolescent development among high-risk settings, American Psychologist, 48, 117-126. Johnston, L., O'Malley, P., Bachman, J. (1988). Drug use among American high school students, College students and other young adults. National trends through 1991. National Institute on Drug Abuse. Research Monograph Series, (1979). Cigarette Smoking as a dependence Process. National Institute on Drug Abuse. 23 f:\12000 essays\health & humanities (196)\The Decision That Could Have Been.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Decision That Could Have Been Everyday people make decisions that affect their future lives. Do people make the right decisions? What makes a decision a right one? What may be right to some, may be wrong to others. There are no right or wrong decisions but those that people choose and believe to be right varying from each individual. In Hemingway's realistic story, Hills Like White Elephants, Jig attempts to make a crucial change in her life by making the right decision, but is unable to because of her weak characteristic flaws. Jig is indecisive about her decision. Even though she realizes the possibilities, she has difficulties letting go of old habits, has a low self-esteem that leads to her being submissive, and puts up a frail fight by hiding her feelings behind her sarcastic comments. Jig faces an immense decision that will change her future. She must choose between the old and the new lifestyle. It is hard for her to let go of old habits that consists of taking no responsibility and the sole intention of seeking pleasure. She must go from a young worriedless rebel to a stable adult taking responsibility. It's a hard process since there are three steps to changing: realization, doing the deed, and committing to the change. She definitely realizes she needs to change, but only goes that far. She does walk to the end of the station and looks upon the fertile side of the valley and comments "and we could have all this," but she continues drinking when she knows well that she carries a child in her womb. She even says the alcohol tastes like licorice, that everything tastes the same, and she's getting tired of her same old life. Surely, she must know the possible damage she can cause the baby to have, but does it stop her from drinking? No, this only indicates that she is still not ready to change completely. Even though she wants to change, something, perhaps her old ways, is holding her back from doing so. Maybe this explains why she drinks during her pregnancy. Jig has many characteristics that define her as being a weak character. Due to her submissive quality, she gives in to her lover regardless her own feelings. One of the reasons why she feels the need to make him happy lies in her fear of losing him. "And if I do it you'll be happy and things will be like they were and you'll love me?" Apparently, Jig is willing to sacrifice her own will for his, if it means making him happy. She struggles on a decision between her mind and her heart. Her mind is telling her to keep the baby, but her heart is telling her the opposite-to go through the operation. It is a decision between her love for him and willingness to make him happy versus her self- interest to make the right decision. Obviously, it is her low self- esteem that gears her towards giving in to him. "If I do it you won't ever worry...then I'll do it because I don't care about me." This quotes clearly shows how she is passive and submissive. Her weak flaw lies in the fact that she doesn't consider her feelings in her decision makings. She pocesses qualities that make her a feeble character incapable of changing and making decisions that make her an unreliable and unwillful character. Another weak flaw is seen through her inability to speak out against her lover. It's as if she tries to avoid any quarrels from occurring. She uses sarcastic means to hide her true feelings about the issue. This is her only way of showing disagreements towards him. Either she is afraid to speak out her real emotions or she is being too tolerant and considerate towards him. When he tells Jig that he's known people who have gone through with it before, she comments, "So have I...and afterwards they were all so happy." On the surface she agrees with him that everything will be the same afterwards, but, underneath she really knows that the abortion will bring them everything but happiness. Her sarcastic usage hides her feeling so well that it seems as if she doesn't even try to tell him she doesn't want to go through with it. At the end, Jig tries one last time to imply to her lover that she disagrees with him by saying, "I feel fine, there's nothing wrong with me. I feel fine." Her sarcastic remark is not a strong way of going about trying to convince him that deep inside something is really bothering her. It can sometimes be confusing for she tells him one thing but means the other. His power over her is so great that she feels intimidated to oppose him directly. Instead, she indicates her opposition towards him indirectly through her sarcastic comments. In conclusion, Hemingway's character Jig in Hills Like White Elephants was unable to change her life through her decision due to her frail characteristics. Some reasons that lead up to her failure were: the hardships of letting go of the old lifestyle, the power Jig's lover has over her due to her low self-esteem and submissive being, and the weakness behind hiding true emotions by using sarcastic means. Jig walked back towards the station into the shades of the sterile side of the valley. A dark cloud covered her head and she knew what was going to become of herself after the "simple" operation. In the end, everyone must choose and follow their own paths, whether their decisions were right or wrong, each direction leads to the beginning of a new journey. f:\12000 essays\health & humanities (196)\The Differences and Similarities of Pneumonia and Tuberculosi.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Differences and Similarities of Pneumonia and Tuberculosis Pneumonia and tuberculosis have been plaguing the citizens of the world for centuries causing millions of deaths. This occurred until the creation and use of antibiotics become more widely available. These two respiratory infections have many differences, which include their etiology, incidence and prevalence, and many similarities in their objective and subject indicators, medical interventions, course, rehabilitation and effects. To explore the relationship between pneumonia and tuberculosis we will examine a case study. Joan is a 35 year old women who was feeling fine up till a few weeks ago when she develop a sore throat. Since her sore throat she had been experiencing chest pain, a loss of appetite, coughing and a low fever so she went to visit her doctor. Her doctor admitted her to the hospital with bacterial pneumonia and after three days of unsuccessful treatment it was discovered that she actually had active tuberculosis. This misdiagnosis shows the similarities between the two diseases and how easily they can be confused. Differences in Pneumonia and Tuberculosis Pneumonia Pneumonia is a serious infection or inflammation of the lungs with exudation and consolidation. Pneumonia can be one of two types: lobar pneumonia or bronchial pneumonia. Lobar pneumonia affects one lobe of a lung while bronchial pneumonia affects the areas closest to the bronchi (O'Toole, 1992). In the United States over three million people are infected with pneumonia each year; five percent of which die. Etiology There are over 30 causes for pneumonia however there are 4 main causes which are bacterial, viral, mycoplasma and fungal (American Lung Association, 1996). Bacterial pneumonia attacks everyone from young to old, however "alcoholics, the debilitated, post-operative patients, people with respiratory disease or viral infections and people who have weakened immune systems are at greater risk" (American Lung Association, 1996). The Pneumococcusis bacteria, which is classified as Streptococcus pneumoniae, causes bacterial pneumonia and can be prevented by a vaccine. In 20 - 30% of the cases the infection spreads to the blood stream (MedicineNet, 1997) which can lead to secondary infections. Viral pneumonia accounts for half of all pneumonia cases (American Lung Association, 1996) unfortunately there is no effective treatment because antibiotics do not affect viruses. Many viral pneumonia cases are a result of an influenza infection and commonly affect children, however they are not usually serious and last only a short time (American Lung Association, 1996). The "virus invades the lungs and multiplies, but there are almost no physical signs of lung tissue becoming filled with fluid. It finds many of its victims among those who have pre-existing heart or lung disease or are pregnant" (American Lung Association, 1996). In the more severe cases it can be complicated with the invasion of bacteria that may result in symptoms of bacterial pneumonia (American Lung Association, 1996). During World War II mycoplasma were identified as the "smallest free-living agents of disease in humankind, unclassified as to whether bacteria or viruses, but having characteristics of both" (American Lung Association, 1996). Mycoplasma pneumonia is "often a slowly developing infection" (MedicineNet, 1997) that often affects older children and young adults (American Lung Association, 1996). The other main cause of pneumonia is fungal pneumonia. This is caused by a fungus that causes pneumocystic carinii pneumonia (PCP) and is often "the first sign of illness in many persons with AIDS and ... can be successfully treated in many cases" (American Lung Association, 1996). In Joan's case bacterial pneumonia was suspected because her immune system was weakened by her sore throat and her signs and symptoms correlated with pneumonia. Tuberculosis (TB) Tuberculosis was discovered 100 years ago but still kills three million people annually (Schlossberg, 1994, p.1). Cases range from race and ethnicity. In 1990 the non-Hispanic Blacks had 9, 634 cases while the American Indians and Alaskan Natives had 371 cases (Galantino and Bishop, 1994). It is caused by bacteria called either Mycobacterium tuberculosis or Tubercle bacillus. Tuberculosis can infect any part of the body but is most often found in the lungs where it causes a lung infection or pneumonia. Etiology There has been a resurgence of TB due to a number of factors that include: 1. the HIV / AIDS epidemic, 2. the increased number of immigrants, 3. the increase in poverty, injection drug use and homelessness, 4. poor compliance with treatment regiments and; 5. the increased number of residents in long term facilities (Cook & Dresser, 1995). The tuberculosis bacteria is spread through the air however transmission will only occur after prolonged exposure. For example you only have a 50% chance to become infected if you spend eight hours a day for six months with someone who has active TB (Cook & Dresser, 1995). The tuberculosis bacteria enters the air when a TB patient coughs, sneezes or talks and is then inhaled. The infection can lie dormant in a person's system for years causing them no problems however when their immune system is weakened it gives the infection a chance to break free. Types of TB Treatments Types of treatment will depend on whether the patient has inactive or active tuberculosis. To diagnose active TB the doctor will look at the patients' symptoms, and outcomes of the skin test, sputum tests, and chest x-rays. A person has active tuberculosis when their immune system is weakened and they start to exhibit the signs and symptoms of the disease. They also have positive skin tests, sputum tests and chest x-rays. When this occurs the treatment is more intense. The disease is treated with at least two different types of antibiotics in order to cure the infection. Within a few weeks the antibiotics will build the body's resistance and slow the poisons of the TB germ to prevent the patient from being contagious. An example of treatment would be short-course chemotherapy, which is the use of isoniazid (INH), rifampin, and pyrazinamide in combination for at least six months (Cook & Dresser, 1995). The drugs need to be taken for six to twelve months or there may be a reoccurrence. Failure to take the antibiotics consistently will result in a multi-drug resistant TB (MDR TB) which "is much harder to treat because the drugs do not kill the germs. MDR TB can be spread to others, just like regular TB" (American Lung Association, 1996). Inactive tuberculosis is when a person is infected with the tuberculosis bacteria, but their immune system is able to fight the infection, therefore only showing a positive skin test and a negative x-ray and sputum test. The patient may be infected but they are not contagious which means the doctor will start a preventative treatment program. This program includes the use of the drug isoniazid for six to twelve months to prevent the TB from becoming active in the future. Once the treatment for Joan's pneumonia was unsuccessful it was rediagnosed because she remembered her exposure to TB when her grandfather contracted it when she was seven years old. She has been unaware that she has been caring the infection in a dormant state for 28 years. Due to her sore throat, which weakened her immune system, her TB became active therefore she was given a new treatment plan. This plan included the use of isoniazid, rifampin, and pyrazinamide. The Similarities of Pneumonia and Tuberculosis Objective and Subjective Indicators Tuberculosis and pneumonia have similar objective and subjective indicators because they both cause infection of the lungs. Because of theses similarities in the indicators Joan's case was easily misdiagnosed without the information of the TB exposure. The subjective indicators are chest pain, headaches, loss of appetite, nausea, stiffness of joints or muscles, shortness of breath, tiredness and weakness. The patient has to be able to tell the doctor these symptoms in order for the correct diagnosis to be made because of the overlap between the two diseases. The objective indicators include coughing, chills, fever, night sweats and blood-streaked or brownish sputum. These signs will be observable by the doctor. Medical Interventions The diagnostic procedures for pneumonia and tuberculosis is also similar. The usual procedure is for the doctor to get a previous medical history along with a history of possible exposure and onset of symptoms. From there a physical examination will occur. The doctor will listen to the patients chest for crackles. After that, tests such as the CBC blood test, x-rays, blood and sputum test, biopsy or a bronchoscopy can confirm an infection of the lungs. A tuberculosis specific test is the Mantoux test which is a skin test that confirms the presence of the TB bacteria in the patients system. A conservative treatment would include antibiotics such as penicillin and isoniazid (INH) that would treat the infection in the lungs. Or bronchodilators may be used to help keep the airways open. Other treatments may include a proper diet or bed rest. There are not many choices when it come to surgical management for pneumonia or tuberculosis. In fact there is usually only one that is often used. That surgery is thoracentesis and it is used to remove the pleural effusion from the lungs. The Course The course of pneumonia and tuberculosis can vary from person to person. In general the course begins with the development of symptoms and the visit to the doctor. After the visit to the doctor tests and examinations will occur to confirm the presence of pneumonia or tuberculosis. Once the infection has been confirmed medication may be prescribed along with possible bed rest. A prompt recovery can occur if: 1. they are young, 2. their immune system is working well, 3. the disease is caught early and; 4. they are not suffering from other illnesses. Most patients will be able to respond to the treatments and begin to improve within a couple of weeks. Throughout the treatment medical evaluation, drug monitoring and bacteriology is completed. They will check the sputum twice monthly for TB until the smear is negative and the patient is asymptomatic which usually occurs within the first three months (Galantino and Bishop, 1994). For both diseases they will also watch the patient for drug side effects, resistance and compliance. In Joan's case the TB infection was caught too late to use preventive treatments but once it turned active it was discovered after two weeks. Bio-Psycho-Social Effects There are many secondary biological effects from pneumonia and tuberculosis. Tuberculosis and Bacterial Pneumonia can enter the body's blood steam and cause damage or further infection to any part of the body, which includes the kidney, joints, bones, liver, brain, reproductive organs or urinary tract. Other secondary problems that may arise from either disease include anemia, pleurisy, lung abscess, pulmonary edema, chronic interstitial pneumonia, acute respiratory failure, empyema, slowing of the intestines or hyponatremia which is low blood sodium (National Jewish Center for Immunology and Respiratory Medicine, 1989). The patient may also suffer from psychological and social problems throughout the course of the disease. In extreme cases patients may be unable to participate in physical, recreational, or normal day activities which may cause social deprivation or depression. However most patients can expect to keep their jobs, stay with their families throughout the treatment and lead normal lives. In Joan's case she was hospitalized so had become socially deprived and was becoming very depressed. This is in part due to the fact the her treatment was ineffective for the first three days from the misdiagnoses. Goals and Interventions for the Pneumonia or Tuberculosis Patient To facilitate the recovery of patients who have pneumonia or TB there will be interventions from the Physical Therapist, Respiratory Therapist and Social Worker. Each profession will have roles in motivating , supporting and increasing the functional capability of the patient. The most common objectives of treatment include: 1. to decrease discomfort, 2. to facilitate the exchange of oxygen and carbon dioxide in the lungs, 3. to prevent atrophy from the increased bed rest, and 4. to prevent social withdrawal. Rehabilitation Goals and Interventions !. Maintain or increase muscle strength during decreased activity · -provide a progressive resistive exercise program · -promote weight bearing activities· engage in recreational activities and self care activities 2. Maintain or increase mobility of soft tissue and joints during bed rest and decreased level of activity · - provide passive and active range of motion · -recreational activities combining aerobic, stretching, and strengthening 3. Develop, improve, restore or maintain coordination · - practice skills with walking, dressing, hygiene and standing 4. Promote psych-social adaptation to disability and prevent social withdrawal - educate to adapt lifestyle · - get involved in support groups and social interactions · - body positions that decrease discomfort· - Social Worker may help here 5. Alleviation of chest pain and aid in respiration -· use chest physio, oxygen treatments and respiratoy therapy· - teach effective breathing techniques and postural drainage to keep airways open 6.Prevention of reoccurrence · - preventive therapy that includes education on proper diet Joan was referred to see a Physical Therapist, Respiratory Therapist and Social Worker. Her goals where to decrease her discomfort, education to adapt her lifestyle and in different body positions that will promote easier breathing. The Social Worker was also there to encourage her to join a support group to help her cope with the restraints from her disease. Conclusion Every year millions of people throughout the world are affected by the pneumonia and tuberculosis disease. These two respiratory infections have similarities and differences. These similarities stem from the fact that both diseases attack a persons lungs causing inflammation and consolidation. In fact tuberculosis is a chronic infection that can affect the lungs and cause pneumonia. Since both infections cause consolidation indicators like coughing, chest pain and shortness of breath are found in pneumonia and tuberculosis. The problem with these similarities, as was seen in Joan's case, is that it can be easily misdiagnosed when the proper tests are not used. The differences in the two infections are mainly just in their etiologies. For pneumonia there are over 30 different causes but the four main categories are bacterial, viral, mycoplasma and fungal while tuberculosis is only caused by a bacteria called Tubercle bacillus. Fortunately pneumonia and tuberculosis can be kept under control with the use of antibiotics and the earlier that the infection is caught the better chance of a prompt recovery. References American Lung Association. (1996). Pneumonia [Online]. Available URL: http://www.lungusa.org/noframes/learn/lung/lunpneumonia.html American Lung Association. (1996) Tuberculosis [Online]. Available URL: http://www.lungusa.org/noframes/learn/lung/luntb.html Cook, Allan R., & Dresser, Peter D. (Ed.). (1995). Respiratory diseases and disorders sourcebook (6). Detroit: Omnigraphics Inc. Galantino, Mary Lou., & Bishop, Kathy Lee. (1994, February). The new TB. PT Magazine. P. 53-61 MedicineNet. (1997). Diseases & treatments: pneumonia [Online]. Available URL: http://www.medicinenet.com/mainmenu/encyclop/ARTICLE/Art_P/pneumon.htm National Jewish Center for Immunology and Respiratory Medicine. (1989). Med Facts Pneumonia [Online]. Available URL: http://www.hjc.org/MFhtml/PNE_MF.html O'Toole, M. (Ed.). (1992). Miller-Keane encyclopedia and dictionary of medicine, nursing, and allied health. Toronto: W.B. Saunders. Schlossberg, David. (Ed.). (1994). Tuberculosis (3rd ed.). New York: Springer - Verlag. f:\12000 essays\health & humanities (196)\The Effects of Anabolic Steroids.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ You've seen them, and you thought you knew what was going on. The muscle-heads at the gym, the all-star basketball player, the amazing offensive tackle, and the lightning fast swimmer. All of them used steroids, and you knew it. They were all unnaturally strong, and looked like gods. But what you could not see is the terrible side effects which come through the use of anabolic steroids. These powerful drugs have both positive and negative results from their use. Along with increased strength and size, users of steroids suffer from ailments like cancer, bad acne, hair loss, damaged organs and intense mood swings. Anabolic steroids are a group of muscle building chemicals, which are synthetic versions of the male hormone, testosterone. Developed in 1935 they were prescribed to aid in muscle and tissue repair by those who had undergone surgery or had degenerative diseases. Now they are used by athletes and patients alike. But they are illegal to use if not prescribed by a physician, and have been banned by nearly all athletic organizations, both professional and amateur. When you think of someone who uses steroids you typically picture someone who is massive, and whose muscle mass is very well defined. A picture comes to mind of the giant body builder, who is so big he can't touch his back because his biceps are in the way, but he can manage to bench press his car. The possible growth and development is amazing. With much less work necessary, the results can be astounding. Athletes can get bigger, stronger and faster, with less effort than previous. The limits of an athletes potential with steroids seem to be unbounded. These are the positive aspects to the use of steroids. One study showed that as much as ten pounds of lean muscle mass could be gained by a mature adult using steroids over a years period. The resulting size and strength increase would be greater more easily attained than without use of steroids.(Taylor pg 45) Also, the type of body structure that may males are looking for can be easily obtained through the use of steroids. Large pectoral muscles, as well and big biceps and a well defined stomach are what many teenage users are after. Society dictates what the current trends are, and our society has dictated that athletic looking men (and women) are in. But not everyone can be so fortunate to have a beautiful body with their given gene pool. So through the use of steroids, people can attain the wonderful body that they so desire. One ex-user commented that after he had used steroids and bulked up, he was much more popular with the females, and got much more respect from his male peers.(Deacon pg 52) Steroids are also used for therapeutic applications as well, although their use here is much less well known. Steroids can be used to promote healing in patients who have recently undergone surgery, they also improve the appetite and increase protein production. They also help protect blood for producing bone marrow after radiation therapy. Also, steroids can be used to help treat skeletal disorders such as osteoporosis broken bones because they aid in the reconstruction of the bone matrix.(Goldman pg 201) The positive effects of steroids are quite obvious, and quite powerful. Unfortunately, the use of steroids tends to result in many damaging side effects in the users. The mournful stories of dominating athletes who used steroids, who are no longer great at their one time profession seems to dot the newspaper pages quite regularly. They always say that they realized too late the damaging effects that the drugs had on their bodies. Steroids can have many different and adverse reactions with the human body. Some effects are only cosmetic: hair loss on the head, and a increase of hair on the back, chest and abdomen of males is sometimes present. Greater concentrations of acne has also been traced to the use of steroids, as has gynecomastia, the development of abnormal breast tissue in males, although this is much less frequent.(Yesalis pg 115) More dangerous results are symptoms such as heart disease, impaired glucose tolerance, hypertension, liver toxicity, jaundice and tumors have all been linked to the use of anabolic steroids. Steroids tend to increase blood pressure, which makes the heart pump harder, eventually weakening it. They also prevent the removal of cholesterol from the walls of veins, which can also have negative effect on the body. In the liver, elevated levels of bile can be present, as well as peliosis hepatis or blood pools in the liver. Also liver cancer has been linked to the use of steroids. They can also cause tumor's in the kidney, known as Wilm's tumor, which is another form of cancer. Also, the extended use of steroids can cause the tendons to lose their elasticity, and begin to break or tear after extended use of steroids.(Goldman pg 131) Another problem common to the use of steroids is a psychological phenomena commonly known as "'roid rage". This constitutes a more aggressively natured person, who is more subject to mood swings. A typically calm, intelligent person could be transformed into a crazed senseless being. The slightest upsetting factor could set them off. These mood swings and shifts tend to be temporary and cease after discontinued use of the drugs, but some of the other effects are lasting, and can be extremely devastating. Less harmful, but important as well is the fact that steroids are banned by nearly every athletic organization, and if it is determined that an athlete used steroids, all medals, trophies, prizes and glory can be stripped away. Athletes who train with the use of steroids are taking a huge gamble. Although steroids can have amazing results, and seem to be the greatest thing on earth, they also hold a cornucopia of terrible things in store for the person who uses them irresponsibly. They must evaluate for themselves if the potential physical prowess that they could attain through the use of steroids is worth the possibility of the devastating side effects. They must also keep in mind the consequences that they could encounter if they do use steroids, which are an illegal drug. f:\12000 essays\health & humanities (196)\The Heart Its Diseases and Functions.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Introduction You need your heart for all your body needs. It pumps about 2000 gallons of blood a day. It takes about 20 seconds for blood to reach every cell in the body. An artery carries blood out from the heart. A vein carries blood back to the heart. An average adult heart weighs about 10-13 ounces (300 to 350 grams). The rate which the heart pumps varies depending on what your doing. When at rest the heart pumps more slowly. When you run the heart rate increases to provide muscles and other tissues with additional oxygen they need. The typical heart rate is 72 beats per minute. Each beat gives out 2-3 ounces of blood pumped into the arterial system. At this heart rate it beats about 104,000 times a day. The Superior and Inferior are the biggest veins in the body. The Superior is really the biggest. These veins have a lot of carbon dioxide and have oxygen-poor blood. The aorta is the biggest artery in the whole body. Which will be covered in the report. The pulmonary vein takes the blood out of the heart and takes it to the lungs. Today we will talk about many different parts of the heart: The Three Layers of Muscle, Atriums, Ventricles, Systole and Diastole, Treatments for the Heart, Valves, and many Diseases. The Three Layers of Muscle The heart has three layers of a muscular wall. A thin layer of tissue, the pericardium covers the outside, and another layer, the endocardium, lines the inside. The myocardium is the middle layer and is the biggest of all. Myocardial Infarction is a disease later read about in this report. The pericardium is a fibrous sac which is very smooth lining. In the space space between the pericardium and epicardium is a small amount of fluid. This fluid makes the movement of the heart muscles smooth. Myocardium is the heart muscle itself. Atriums The right atrium is a low pressure pump that moves blood into the right ventricle through the tricuspid valve. The atria are the two upper chambers of the heart. The right atrium receives blood from the veins which is low in oxygen and high in carbon dioxide; this blood is then transferred to the right lower chamber, or right ventricle, and is pumped into the lungs. Ventricles The ventricle is a muscular chamber that pumps blood out of the heart and into the circulatory system. Right Ventricle The right ventricle has a thicker and stronger muscular wall than the right atrium. The right ventricle pumps the oxygen-poor blood through the pulmonic valve into the lungs where blood gives up carbon dioxide it has carried from tissues. At the same time blood absorbs oxygen. From the lungs pumping action moves blood to a receiving chamber on the other side of the heart. The left atrium, gently pumps the blood to the left ventricle through the mitral valve. Left Ventricle The left ventricle gives a powerful pumping action to send the oxygen enriched in blood into the aorta. The aorta is the principal artery which subdivides and delivers the blood to the body's tissues including brain, organs, and extremities. Systole and Diastole Systole is the contraction of the ventricles of the heart which forces blood out. Diastole is the relaxation of ventricles to allow blood to enter. Treatments for the Heart Angioplasty is a technique used to clear arteries that have become blocked with fatty deposits. Angiography is used to x-ray the blood vessels. Valves In the heart there are two valves that prevent backflow of blood from the ventricles into the atria. On the right side of the heart is the tricuspid valve, composed of three flaps of tissue; on the left is the two-piece mitral valve. DISEASES Congenital Disorders Range of minor to serious congenital disorders are very evident at or shortly after birth. Ventricular Septal Defect Ventricular Septal Defect is most common for heart malformation. An infant born with a defect has an opening between the lower chambers (ventricles) of its heart so there is an increased blood flow from the left side to the right side because the left side has more pressure than right side. The lungs at this state are under very high in pressure. Treatment for this disease depends on it size of defect. About 30%-50% of small defects close spontaneously during the first year of life. Artrial Septal Defect Atrial Septal defect is a opening which is high in the heart between the upper chambers (atria). This disease is more common in female infants than in male infants, and it often occurs with children who have Down syndrome. Disorders of Heart Rate and Rhythm The control mechanism for heart rate involves electrical impulses. One of the four chambers, right atrium, contains group cells called sinus node. The sinus node acts as a pacemaker, which produces electrical impulses that signal the muscle of the heart to expand and to contract in the pumping cycle. The heart rate of a human can get up to 200 beats a minute if you exert yourself. If something goes wrong with the sinus node and normal pacing of heart is disturbed or bothered, one of a number of rhythmic disorders can happen. Too rapid or fast of a heartbeat is called tachycardia, and too slow of a heartbeat is called bradycardia. The heart can also be affected by tobacco or use of other drugs. Heart Arrhythmias Here are some signs of this disease: None, skipped heartbeats, light-headedness, chest discomfort, and shortness of breath. If the rhythm of heart beat is disturbed problem is arrhythmia. You maybe unaware of the problem. Heart Murmurs Heart murmurs can be heard by a physician as a soft hissing sound which follow the normal sounds of heart action. Heart murmurs can tell you if that blood is leaking out through a valve and can signal a serious heart problem. Heart murmurs can sometimes fix themselves. Myocardial Infarction Myocardial infarction is a disease of myocardium muscle in the heart. Heart muscle and it's linings can get a disease for instance myocardial infarction. You might not have done anything wrong even though, but it still could happen. Myocardium gets blood from the coronary artery. When not enough blood reaches the this muscle it is called myocardial infarction. It is usually rare, but it can damage the heart muscle very badly. Cardiomyopathy Here are some signs for this disease: short times of fast heartbeats, breathlessness, weakness, chest pain, fainting, and fluid retention. Fluid retention is also known as redema. Redema means swelling of body tissues due to excessive fluid. When the muscle of the heart is damaged or defective it could led to a disease known as cardiomyopathy. This could happen by bacteria or enlargement of the wall. Diseases and Disorders for Heart Valves Each valve consists of 2 or 3 thin folds of tissues. When closed valve prevents blood from flowing to the next chamber or from returning from the previous one. When a valve opening is narrowed and flow through is limited, the condition is stenosis. Each valve may be subject to stenosis or obstruction. In some cases a valve will lose its shape or sag (prolapse) or fail to close which causes a back flow of blood (regurgitation) could also be caused by infection or congenital problems. Tachycardia Tachycardia occurs normally during and after exercise or during stress and represents no danger to healthy individuals. In some cases, however, tachycardia occurs without apparent cause.The heart can beat as many as 240 times per minute in tachycardia. Tachycardia can be ended by lying down. Vascular System and Diseases of It The vascular system consists of blood vessels in the body. The vessels become smaller as they extend farther from the heart. The aorta delivers its flow to large arteries into smaller vessels. Arterioles supply tiny capillaries which nourish tissues. Oxygen is going from the capillaries to the tissues, and carbon dioxide from tissues taken up into the capillaries. Arteries have to be strong as well as flexible because of the pressure of the blood being pumped through the venous system. Veins get bigger when they get closer to the heart. Disorders of Blood Vessels A disease or a disorder for the blood vessels can be fatal. Coronary Artery Disease The coronary arteries supply and maintain the myocardium. Coronary artery disease can cause a heart attack or hypertension when blood vessels get small or filled up with cholesterol, scar tissue, or calcium. Other problems can happen also. For instance disorders for the heart valves or for the heart muscle and pericardium. Conclusion The heart is something you need every day you can't live with out it. Exercise, eat a balanced diet, and always have checkups. People don't think a checkup will really do anything, but believe it because it will. You might not know you have something wrong with your heart or something else in your body and then you might get ill. So, don't eat junky foods too often. Keep your heart safe and healthy as long as you can. Today I have talked about the heart and many other things as well such as the diseases of the heart, the vascular system, and more. This Concludes My Report f:\12000 essays\health & humanities (196)\The Hormonal Control of Sexual Development.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The objectives of this article as I saw them were, (1) to show how fetal gonads acquire the ability to function as endocrine organs, and (2), to show the mechanisms by which the endocrine secretions modulate male development. The researchers went through an extremely extensive explanation of the formation of the sexual phenotypes by detailing the development of germ cells. They explained how women's and men's gonads appear identical until Leydig cells, which synthesize testosterone, appear in the connective tissue. This is when differentiation begins. The mechanism that this differentiation occurs is as follows. There are two duct systems which are basically sex specific. In men, Wolffian ducts are dominant and Mullerian ducts are regressive. Whereas in women it is just the opposite. Jost believed that the fetal testis secret a hormone which causes such a differentiation. In order to confirm this belief, he removed the gonads from embryos, prior to the onset of phenotypic differentiation. All resulted in female phenotypes. The male phenotype is induced and will not manifest if the proper secretions are not made from the testis. Although the article fails to mention how, "Jost deduced that two secretions from the fetal testis are essential for male development - Mullerian-inhibiting substance and androgen." The mechanism in which spermatogenic tubules form Mullerian-inhibiting substance is still unclear to scientists. Problems with improper levels of this hormone result in genetic and phenotypic reproductive disorders. The other hormone secreted by the testis is testosterone. It has two functions; it promotes maturation of the spermatogenic tubules (and is therefore indirectly effecting the levels of Mullerian-inhibiting substance), and it has its well known essential role in the development of the male genital tract. Throughout this article there were several areas where it seemed to me, issues were unresolved, however seemed to me that we have the technology to resolve them. For instance "The Character of the acceptor sites within the nucleus (that is, whether protein or DNA) and their number are not resolved." Couldn't one do a radioactive trace or a non-vital stain of some sort to distinguish the protein from the DNA. The development of one's sex is therefore far more than just a genetic decision, it is (once again) a complex cascade of hormones acting on receptors. These receptors go on to activate effector molecules which activate target molecules. If at any point this system is disrupted in any way, one either has the underdevelopment or incorrect development of the phenotypical gonadal characteristics. f:\12000 essays\health & humanities (196)\the Hot Zone.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Ebola and Marburg viruses are extremely lethal viruses that have placed repugnant thoughts on the minds of many people that have any background knowledge on this field of viral infections. Where does it come from? Where does it hide? What could it do to me? As these questions burn holes in the minds of many people, something should be done to learn more about these horrendous viruses. People sometimes become scared stiff from the thought of the bone-chilling effects from these viruses, and had good reason to. "Ebola, the slate wiper, did things to people that you did not want to think about. The organism was too frightening to handle even for those who were comfortable and adept in space suits." (paperback pg.63-64 - Project Ebola). A large, shy man by the name of Gene Johnson was the first pioneer to venture out to find the roots of the Ebola and Marburg viruses. Gene spent many years in Central Africa looking for these viruses. After digging up virtually every piece of land in Central Africa, Gene Johnson wound up without a single case or report of a virus. A man by the name of Charles Monet and a young boy referred to in this book as Peter Cardinal both contracted the same level 4 hot virus. There is only one connection between Charles and Peter. "The paths of Charles Monet and Peter Cardinal had crossed at only one place on earth, and that was inside Kitum Cave." (pg. 140 - Cardinal). Kitum Cave is where the virus is expected to be living or where the history of the Ebola virus lays. So Kitum Cave is where the search for the deadly virus begins. Led by Gene Johnson, the team members on the Kitum Cave expedition set up many differing animals inside the cave with the hope that one of the animals would contract the virus. Even though the expedition's results came out negative, Kitum Cave is still the only logical place where the virus thrives. There have been a handful of outbreaks as the cause of a shipment of monkeys to a civilized community. For example, this occurred from a monkey shipment to an old city in central Germany. Killing 7 out of the 31 people it infected, this virus would later be named after the city it erupted in, Marburg. The monkeys posed as the host in this terrifying disaster. The possibility that humans are the natural host is very, very unlikely. "...its original host was probably not monkeys, humans, or guinea pigs but some other animal or insect that it did not kill. A virus does not generally kill its original host." (pg. 139 - Cardinal). It is almost like man carrying a bomb that will go off no matter what. He is not immune to that bomb, it will destroy him. It is not possible that he could have been the natural host to that bomb. It is the same story with Marburg and Ebola. You can't carry a bomb with you and not let it do its damage. There are also theories as to where the virus lives. Most of the theories coming from Kitum Cave. Just as these quotes from the book suggest. "Maybe the virus lives in nettles." (pg. 392 - Camp). Inside the cave, theories included insects. "The insects floated like snow blown sideways. The snow was alive. It was a snow of hosts. Any of them might be carrying the virus, or none of them." (pg. 393 - Camp). The Marburg and Ebola related viruses are scary enough to scare a small speedo off a two ton elephant. As the hunt continues, the mystery lurks deep in the forests of Africa. f:\12000 essays\health & humanities (196)\The Immune System.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ THE IMMUNE SYSTEM The immune system is a group of cells, molecules, and tissues that help defend the body against diseases and other harmful invaders. The immune system provides protection against a variety of potentially damaging substances that can invade the body. These substances include disease-causing organisms, such as bacteria, fungi, parasites, and viruses. The body's ability to resist these invaders is called immunity. A key feature of the immune system is its ability to destroy foreign invaders while leaving the body's own healthy tissues alone. Sometimes, however, the immune system attacks and damages these healthy tissues. This reaction is called an autoimmune response or autoimmunity. The immune system is composed of many parts that work together to fight infections when pathogens or poisons invade the human body. Pathogens are disease- causing organisms such as bacteria and viruses. The immune system reacts to foreign substances through a series of steps know as the immune response. Any agent perceived as foreign by a body's immune system is called an antigen. Several types of cells may be involved in the immune response to antigens. When an antigen enters the body, it may be partly neutralized by components of the innate immune system. It may be attacked by phagocytes or by performed antibodies that act together with the complement system. The human immune system contains approximately 1 trillion T cells and 1 trillion B cells, located in the lymphoid organs and in the blood, plus approximately 10 billion antigen-presenting cells located in the lymphoid organs. To maximize the chances of encountering antigens wherever they may invade the body, lymphocytes continually circulate between the blood and certain lymphoid tissues. A lymphocyte spends an average of 30 minutes per day in the blood and recirculates about 50 times per day between the blood and lymphoid tissues. Lymphocytes are special types of white blood cells. Like other white blood cells, lymphocytes originate in the bone marrow, the blood-forming tissue in the center of many bones. Some lymphocytes mature in the bone marrow and become B lymphocytes, also know as B cells. The B stands for bone marrow derived. Some of these cells develop into plasma cells, which produce antibodies. Antibodies are proteins that attack antigens. They are carried in the blood, in tears, and in secretions of the nose and the intestines. Other lymphocytes do not mature in the bone marrow. Instead, they travel through the bloodstream to the thymus, an organ in the upper chest. In the thymus, the immature lymphocytes develop into T lymphocytes, also knows as T cells. The T stands for thymus derived. The B lymphocytes are responsible for the production of the blood-serum components called immunoglobulins. The T lymphocytes are responsible for attacking and killing antigens directly. Both T and the B lymphocytes have the ability to remember previous exposure to a specific antigen, so that if the same antigen enters the body the T and B lymphocytes can take faster and better action against it. There are many disorders that disrupt the immune system's operations. The most serious are the disorders called immunodeficiency diseases, such as AIDS. These diseases can lead to death. Immunodeficiency diseases are among the most severe disorders of the immune system. People afflicted with such conditions lack some basic feature or function of their immune system. As a result, their immune system fails to respond adequately to harmful invaders. For this reason, people with immune deficiency diseases suffer from different kinds of illness. Allergies are mistaken and harmful responses of the body's immune system to substances that are harmless to most people. The substances that provoke an allergic reaction are called allergens. They include pollen, dust, mold, and feathers. Among the common allergic diseases are asthma, eczema, which is an itchy red swellings of the skin, hay fever, and hives. If lymphocytes encounter an antigen trapped by the antigen-presenting cells of the lymphoid organs, lymphocytes with receptors specific to that antigen stop their migration and settle to mount an immune response locally. The process of inducing an immune response is called immunization. It may be either natural, through infection by a pathogen, or artificial, through the use of serums or vaccines. The immune system cannot protect the body from diseases by itself. Sometimes it needs help. Physicians give their patients vaccines to help protect them from certain severe, life-threatening infections. Vaccines and serums boost the body's ability to defend itself against particular types of viruses or bacteria. f:\12000 essays\health & humanities (196)\The Nursing Home A Haven for the Elderly.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Nursing Home: A Nice Place for the Elderly A.) Security 1.)Curfews 2.)Lost faculties (No need to drive) 3.)Away from con-artists B.) Activities 1.)Entertainment/Songs (Brownies example) 2.)Activities/Crafts (Beta Club example) 3.)People of similar age C.)Health Care 1.)Takes stress off of the family 2.)Help with prescriptions and medicine 3.)In case of emergency... The Nursing Home: A Haven for the Elderly Today's nursing homes are excellent environments for our elderly. These establishments provide health care, entertainment, security, and above all, a home for over 1,000,000 American citizens over age 70. There is no better place for an individual who is slowly losing his or her faculties. During one's "golden years," one should not have to worry about daily chores like washing the dishes or mowing the lawn. One should be able to relax and enjoy life. Nursing homes give the elderly a chance to do just that. Security is a primary focus in most nursing homes. Curfews exist to insure the safety and protection of the residents. Also, busses take the senior citizens to places of common interest, such as the grocery store and local shopping malls. This alleviates the everyday stress of driving for those residents who are losing some of their basic faculties, and creates a safer driving environment for everyone. In addition, these older citizens are protected from those con-artists who prey deliberately on the elderly. Nursing homes are full of entertainment and activities. I recall visiting a local nursing home with my second grade Brownie troop. We sang songs and made crafts with the residents. It was an enjoyable experience for everyone. Just last year, I went with my high school's Beta Club to a nearby nursing home where we held a Valentine's Day party with cake and ice cream for all of the residents. They really enjoyed our company. Aside from outside visitors, residents have the opportunity to make new friends within the home itself. Since everyone is generally the same age, most have a great deal in common and get along well with their 'neighbors.' Of course, the primary purpose of today's nursing homes is health care. Family members can rest assured that their older loved ones are taken care of, day and night. This removes a great stress from the family of an elderly person who can no longer care for him or herself. The facility helps residents with their prescriptions and medicines. Nursing homes are usually located near hospitals to ensure quick treatment. And in case of an emergency, trained professionals are on site. What a multipurpose establishment! Security, entertainment, and health care. These days, there is no better place for our elderly. It is obviously the best choice for those senior citizens who desire a low-stress, yet highly entertaining atmosphere. Honestly, after fifty-plus years working at a full-time job, do you really think you'll want to get out the mower? f:\12000 essays\health & humanities (196)\The Pressure to be Perfect.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Pressure to be Perfect In today's competitive society, a person strives for perfection, due to the fact that so much emphasis is placed on one's outer appearance. No matter who we are or where we live, society puts this pressure upon us. We are typically faced with this pressure by models on television and in magazines. Companies seem to have targeted women more so than men. They usually use women with good looks and nice figures to advertise and market their product. When companies use these women in advertisements, it is setting a standard that other women feel that they need to follow. What has happened to internal beauty? Society puts so much importance on external beauty that people have forgotten about an individual having beauty within. The sayings "beauty is in the eye of the beholder" and "beauty is only skin deep" come to mind when I think about just how much emphasis is placed on outer appearance. A major factor that has increased the percentage of overweight people in society is technology. This includes items such as elevators, escalators, garage-door openers, drive-in windows, and the remote control. It use to be that you would at least burn some calories by having to get up and turn the channel on the television, but thanks to technology it is now a push of a button. Just think, things have the possibility to grow increasingly worse because of the 'information super highway'. There is no need to get out and walk the malls in search of a particular item or gift. With the use of the 'super highway' you just need a credit card and the item is delivered to your doorstep. Can technology be causing more harm than good? One of the most disheartening facts is that there are people and companies that are benefiting from those who continue to struggle with weight loss. Magazine publishers boost sales by promoting articles on how do lose weight. Book publishers and self-improvement Gurus profit from the diet books and weight loss programs that they sell. Where as, manufactures capitalize from the selling of home-based exercise equipment. Weight loss franchises and the purchasing of diet products such as liquid diets and pre-packaged frozen meals are the main contributors to the ones who benefit from the weight loss struggle. These are just some of the beneficiaries of over 50 billion dollars spent every year on weight loss products that promise results. The images that I chose to represent my topic of "The Pressure to be Perfect" are ones that show just how perfect society wants us to become. They are all of women because that is the focal point of society. On a whole, most women will never be able to look the way that these models do. The models have devoted themselves to looking flawless in order for their careers to survive. They have the time to make their body into the perfect form that it is in. However, tell me what woman in today's society has time to devote to just to her body. Women live in a fast paced, rat race of a life and seldomly have time to give to just their bodies. Advertisers kind of send out a false message. Sure it is more appealing to look at a women with a slender physique, but it is the product that you should be concerned with. I am sorry to say, but by wearing a particular article of clothing or consuming some product it will not make you look like that model. If you turn on a talk show today, you are likely to see an overweight person sharing the hurt and outright prejudice that they have suffered from society. The audience smugly tells them to diet and show some will power. Overweight and obese people wish it were that simple. Fitting into the perfect image that society places on individuals is almost a delusion. Rather than dieting, changes in food selections, an exercise plan, and an attitude adjustment can help you lose the weight and keep it off. There is no way that we can possibly please everyone, but being okay with yourself is the most important thing and if that involves changing your outer appearance; be sure that you are doing it to please yourself and not society. f:\12000 essays\health & humanities (196)\The Roy Adaptation Model.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Roy Adaptation Model Page 1 Roy began work on her theory in the 1960s. She drew from existing work of a physiological psychologist, and behavioral, systems and role theorists. She was keenly interested in the psycho/social aspects of the person from the start and concentrated her education on this aspect of Person. Thus, the language/thinking of psychology and sociology became second nature to her. The need for intense study of the language and ideas behind Roy's Adaptation Model is its biggest drawback in applying it to many clinical areas. The confusion in the physiological mode's categories could be explained by her concentrating on the psych social during her education. In 1980, Roy and Reihl advocated a single unified model of nursing and suggested this would insure stability of the discipline of nursing. They maintained concepts and propositions of other models could be combined in summary statements related to person, goals of nursing and the nursing process. According to Fawcett, this position is a simplistic solution to a difficult problem. Nursing, with its limited experience with metaparadigms and conceptual models, is not ready for restrictions on its ways of thinking. It's my belief that this act of advocating a single unified model was an act of multi-oppressed thinking influenced by men, the Roman Catholic Church and the medical world. During a 1987 conference of nursing theorists, Sister Roy made a number of deferring remarks to a speech made earlier by a male Bishop. Fawcett also says the Roy Adaptation Model has an extensive Page 2 vocabulary and that some familiar words (ie adaption) have been given new meanings in Roy's attempt to translate mechanistic ideas into organismic ones. Oppressed Group Behaviour: -assimilating the values and characteristics of the Oppressors. -Nursing leaders represent an elite group promoted because of their allegiance to maintaining the status quo. -leaders of Oppressed Groups are controlling, coercive and rigid. Oppressors: -education is important to maintaining the status quo. -Roy's Model follows the Medical Model and tends to be Totalitarian and therefore is familiar to Medicine - they would want to encourage it. -behaviour preferred by Oppressors is rewarded. -token appeasement (approval) is given to halt change or revolt. The contributions of this conceptual model are that it will lead to more systematic assessments of clients and an increased quality of nursing practice. It could foster nursing knowledge through organized research and it could provide a more organized curriculum. Roy's definition of person Roy defines the person as an Adaptive Open System. The Systems' Input is: a) three classes of stimuli: focal, contextual and residual, within and without the system and b) the systems' adaptation level or range of stimuli in which responses will be Page 3 adaptive. Inputs are mediated by the systems' Regulator (psychological) and Cognator (Psych/social aspects of person) subsystems. The system runs into difficulty when coping activity is inadequate as a result of need deficits or excesses. System effectors (body organs that become active with stimulation) are the four modes (physiological, self concept, role function and interdependence) that the Cognator and Regulator can demonstrate activity through. Output of the person as system may be adaptive or ineffective. Adaptive responses contribute to the goals of the system ie: survival, growth promotion, reproduction and self mastery. Ineffective responses do not contribute to the systems' goals. The person receives nursing care. Roy implies the client has an active role in care and that he is a bio-psycho-social being who constantly interacts with a changing environment. The focus of nursing is the person. Roy in 1978, commented that although the model may be applied to family, community in society it was developed specifically for the person (medical model influence - Totalitarianism) Perception links the Cognator and Regulator. Inputs to the Regulator are transformed into perception. Perception is a process of the Cognator, responses following perception are feedback into both the Regulator and Cognator. Of the Cognator, there are three modes described by Roy. Self concept is the need for psychic integrity and perception of worth. Role function is the need for social integrity, and interaction Page 4 with others. Interdependence is the balance of dependence/ independence with others. I like the concept of person as open systems and the concept of dividing 'stimuli' into focal, contextual and residual categories. There is definitely a need for more emphasis and understanding of the person's: cognitive coping mechanisms. Again, Roy tends to imply that the person/adaptive system is reacting to and trying to 'fit' into his surroundings - another manifestation of the Roman Catholic fatalistic view of mankind. Persons, family, communities are capable of affecting their environment and letting it affect and expand their capabilities at the same time. It does not have to be 'God's Will'. For example a person does not have to accept that he and his will be struck down by bowel CA, or heart disease. A change in diet, exercise, decreasing stress and not smoking will allow them to alter their future. Because the medical model is so dependent and fixated on treating pathologies, the public has gradually neglected or given up their ability to protect themselves against disease. Think of the health care system or the prevailing medical model as the oppressor and the public as the oppressed. There is a clear understanding that the content of education/information is just as crucial to an oppressed group as access to it. Self esteem, or faith in their own ability to care for themselves and make the right decisions; is low. The doctor or nurse always knows or is right. For example, in the PACU, when we question some patients about their past health and how they feel now, it's very common to Page 5 hear 'I don't know, you should ask my doctor.' When they are reassured that it is their opinion I want, they will answer. If I express surprise that they have suffered so much, for so long, they often say something to the effect of: "I figured if the doctor wanted me to have more treatment/painkiller, he would have given it to me." To paraphrase H. Jack Geiger, a civil rights worker: "Of all the injuries inflicted on the oppressed people, the most corrosive wound within, the internalized oppression that leads some victims, at an unspeakable cost to their own sense of self, to embrace the values of their oppressors." Roy - Health Roy's original model says that health is on a health-illness continuum from wellness to death. The degree of health or illness that the system experiences is an inevitable dimension of a person's life. The Roman Catholic Church, with it's fatalistic view of Human Life may have influenced Roy. Currently, Roy defines Health as a process of becoming an integrated and whole person and a process of being. Health is the goal of the person's behaviour and the person's ability to be an adaptive organism. Adaptation is a process of responding positively to environmental changes. The person encounters adaptation problems in a changing environment especially in situations of health and illness. Adaptive responses to pooled effects of focal, contextual Page 6 and residual stimuli are either positive ie: promote integrity of the system re: goals of survival, growth, reproduction and self mastery, or ineffective (do not contribute to goals). According to Chin and Kramer, theoretical conceptualizations of health as a state of adaption implies conforming or adjusting to environmental stimuli in order to "fit" within the environment. This suggests that (fatalistic) events external to the person are primary as a determinant of health and that person and environment are separate entities. This follows the totality paradigm. Roy's categorization of systems responses to a changing environment as adaptive or ineffective indicates health is seen as a dichotomy (a process of dividing into two mutually exclusive or contradictory groups). Unhealthy or healthy as seen by the medical model is another example of totality or mechanistic paradigms. Fawcett says that no explicit definition of health or illness is given by Roy so it must be inferred that adaptive responses signify wellness and that inadaptive responses signify illness. My view of health is not based as firmly on the medical model or is as fatalistic as Roy's. For example: Anesthesia prescribing Valium pre-op for a normal response to impending surgery and the nurse administering it because it is an accepted (and quick) way of dealing with pre-op jitters. In this case, the doctor and the nurse have decided on a course of action for the patient in place of providing pre-op answers to questions, different options and letting the patient expand his ability to manage his state of health and himself. Roy - Environment/Society Page 7 Environment/Society constantly interacts with the individual and determines, in part, adaptation level. Stimuli originate in the environment. The environment: refers to all the internal/external conditions, circumstances and influences affecting the person, and his development and behaviour. The internal and external environment provide input (or stimuli). The environment is always changing and interacting with the person. The stimuli are divided into focal; contextual and residual categories. Focal stimuli immediately confronts the adaptive system ie: an M.I., a death in the family. Contextual stimuli or "background stimuli" is genetic makeup, sex, maturity, drugs, alcohol, tobacco, self concept, role function, interdependence, socialization, coping mechanisms (Cognator and Regulator), physical and emotional stress, culture, religion, environment. Residual stimuli are beliefs, attitudes, experiences, traits which may be relevant but effects are indeterminate and therefore cannot be validated. Roy's general idea of the role Environment/Society play in the effects on the person make it seem like the person is a fairly passive, adaptive system - only reacting to stimuli from his environment, but not affecting it. My own earlier comments on Environment/Society are basically the same. I's like to emphasize that I've become more aware of the fact that Human beings/families/community can also affect or alter their inner and outer environment. That they don't have to accept the fatalistic view "that it's God's Will.", or that Doctors/Nurses know best. Page 8 The best example is the use of the PCA pumps for pain control. When instructed properly the patient has control over the amount of noxious, focal stimuli in his inner environment. He does not have the stress of waiting to see if the health care worker (Dr, Nurse, etc) is willing to alter his focal stimuli/environment for him. I have found it best in the PACU to hand over the control of the PCA pump as soon as possible as this ability to control this one aspect of their environment has it's own positive analgesic effect on patients. During a 1987 lecture at a nursing theorist conference, Roy made the comment that although it might be the will of the client or the client's family to turn off the ventilator, that "the affects on society as a whole had to be considered, as the Bishop stated in his remarks this morning." To me, this appears to emphasize the idea in Roy's work that the person, as a adaptive system is only to be affected by external stimuli (in society, environment, R.C. church) and is not affecting his environment/society equally, that he should accept his fate. Roy - Nursing According to Roy, the Nurse using the Nursing Process, promotes adaptation responses during health and illness to free energy from ineffective/inadequate responses to increase health and wellness. Goals, mutually agreed on and prioritized, are proposed to meet the global goals of: Survival/Growth Promotion/Reproduction of race/society/attaining full potential or mastery of self. Page 9 The nurse uses activities to increase adaptive and decrease ineffective responses during illness and health. These activities alter or manipulate the client's focal, contextual and residual stimuli and expand his repertoire of effective coping mechanisms. Nursing focuses on the person (adaptive system) as a biopsychosocial being at some point along the health-illness continuum. In contrast, Medicine focuses on biological systems and the patient's disease. It's goal is to move the patient along the continuum from illness to health. Nursing's goal is to increase adaptation in four modes of physiological, self concept, role function and inter-dependence. The nurse acts as an external regulatory force to modify stimuli affecting adaptation of the system (person). For example; instead of using the verbal analogue scale to assess whether I'll continue with I.V. morphine, I prefer to let the patient decide his care. Is a VAS of 4 O.K. for him, is he comfortable enough to rest, breath, move and cough? My views are fairly similar to Roy's as far as the type of information that needs to be gathered before setting goals. It's a good framework for improving assessments of each patient. The emphasis on the Cognator (self concept, role function, inter-dependence) is assuming that all nurses understand the subtle differences between these modes and have the time to interview patients in depth. This concept of nursing could be more easily applied to psychiatric nursing, community nursing, or long term care facilities. Her grouping of needs in the physiological mode are also a source of confusion and frustration at Mt. Sinai where Page 10 I work. For example: a state of hypervolemia or hypovolemia could be under Oxygenation and/or Fluids and Electrolytes. The need to do neurovascular checks could come under Oxygenation/Activity and Rest/or Senses and Neuro functioning. Roy, herself, has said that in acute care areas, a need to prioritize and focus on survival is necessary and that adhering to closely to her model would be cumbersome in such settings. f:\12000 essays\health & humanities (196)\The Safety of Blood.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The Safety of Blood A five-year old girl is riding down the street, on her way to her best friend's house. She doesn't have a care in the world and is quietly humming to herself. Suddenly a car whips around the corner and swerves to avoid the child, but he looses control and squarely hits the girl, causing the her to fall and get trapped between the car and her battered bicycle. A main artery in her leg has been severed and blood fills the gutter of the street. As she gets rushed to the hospital in the ambulance, a pint of blood is given to her to attempt to replace some of the life giving fluid that is pouring out of her leg. In the end she received four pints of blood and made a full recovery. Although everything turned out all right for the girl, things could have been much different. What if that blood hadn't been there because the nation's blood supply was low? What if the blood that she received had been infected with a deadly disease such as Syphilis or HIV? These are pressing concerns for today's society. Even though one in every five people will need a blood transfusion and the risk of contracting a disease such as AIDS is practically negligible, people are still concerned that the blood that they receive may have harmful or deadly diseases and that today's blood supply is not "safe." However, "safe" means different things for different people. For some, safe is an absolute security from any danger. This is an extreme viewpoint, though, because most people realize that one can never be completely safe. Another, and more popularly held connotation of "safe," is the probability of not getting hurt. This is a much more reasonable and plausible definition and therefor will be used throughout this paper. However, even though the overwhelming probability is that nothing will go wrong, people still fear that the nation's blood supply is unsafe. They are incorrect in this belief, though, because much is done to assure that the nation's blood supply is, in fact, safe. One requirement to having a safe blood supply is to have an extensive reserve, because this allows for the option of discarding any blood that is potentially unsafe. The assurance of an ample blood supply begins with the donation process. Most of the people in this country have the capability to donate blood. However, only 4 percent of the eligible population actually donates.1 There are few restrictions and the reason why there are blood shortages is because people don't want to donate as opposed to can't donate. For most blood centers, the physical criteria that a donor must meet are as follows: person must be at least 17 years of age, weigh 110 pounds, and be in good physical health. However, if so many people can donate blood why do so few choose to? Most people are afraid of giving blood. There are many misconceptions about the process of donating blood and receiving transfusions. For example, people believe that there is a danger of contracting diseases, especially AIDS, from the needles used during the process. However, these chances are zero, and a person has less of a chance of contracting a disease while giving blood than he has in any other ordinary situation Actually, people have little to fear about giving blood. Many precautions are taken to assure that the process is safe for the donor, and the blood that is received is safe for the recipient. Before the donor even gets close to the bed or the needle, he first must complete a thorough survey asking about his past and potentially risky behavior. The survey asks about recent sexual encounters, focusing on homosexual situations. It also asks about drug use, body piercing, and prostitution, which are all considered to be "at risk behaviors." If the donor has participated in such behavior he will not be allowed to donate until a time when it is safer for everyone involved. If the donor passes the screening, his blood is collected in a new, plastic bag with a brand new needle. The needle and everything used during the process, from the finger lancet to the cotton swabs, are disposed of instead of being reused, which eliminates the possibility of something not being properly sterilized. Also, if by chance, the nurse misses the vein and must reinsert a needle, he will start over with a new needle, to assure sterility. After the blood is drawn, it is sent to certain laboratories, where it is tested for diseases such as HIV. If there is a problem, the donor will even be notified to assure that he or she doesn't put anyone else at risk. At any point in this process, blood that does not reach the proper standards will be removed from the supply, assuring safety. In fact, two to ten percent of the units of blood that are received end up being removed because of uncertainty. 2 Another reason why people may be hesitant to donate is because they don't know the benefits of giving blood. First, because of the screening process, the donor receives a sort of mini-physical every eight weeks. This lets a person keep a check on his or her blood pressure, pulse, temperature, weight, and iron reading. It is a good way to assure that one is remaining healthy. Also, not only does the blood that is given help someone in desperate need of it, the donor feels good about himself, too. The donor can walk out of the center with a firm sense that he has helped someone in need. After the blood is drawn, many tests are performed on it, providing another way to insure that the blood supply is safe. Testing is done for Syphilis, Hepititis B and C, abnormal liver function, and Human T-Lymphotrophic Virus type I and type II. All of these diseases are blood-born and have the potential of being extremely harmful if not fatal. However, the main fear that people have regarding a blood transfusion is that they may contract AIDS. This is a result of a lack of understanding about what AIDS is or how it is tested. AIDS, an acronym for acquired immunodeficiency syndrome, is a blood-born disease that attacks one's immune system, leaving him susceptible to lesser diseases that may not be a threat to a person with a healthy immune system. It is caused by a virus known as HIV (human immunodeficiency virus) and over a few years develops into AIDS. The only ways to contract HIV are through bodily fluids: blood, semen, vaginal fluid, or breast milk. It is because blood is one of the means of contracting the disease, many people are afraid of donating and receiving blood. However, HIV is also one of the diseases thoroughly tested for in the testing process. Two HIV related tests are performed, one for the HIV antigen and the other for the HIV antibody. The purpose of testing twice is to assure that the presence of the disease is noticed. If a person tests positive for either the HIV antigen or antibody, he is permanently deferred, meaning that he will never be allowed to donate.1 The main reason why people are concerned about the safety of the blood supply is because they are afraid of contracting a disease in the event that they need to receive blood. However, precautions are also made to insure the safety of blood transfusions. For example, all of the blood used for transfusions either comes from the blood center or is drawn by the same methods. This insures that the level of sterility and testing for harmful diseases is as high as it is for donation. In the hospital, sterile one-use needles are also used as they are in the blood center. Also, careful screening is done to make sure that the blood types match and that the donor blood is compatible with the a patient's blood, preventing diseases such as jaundice. In both the blood center where the donations take place and the hospital where the transfusions occur, the staff is highly trained and knowledgeable. Each nurse or assistant must have basic medical training to get the job, and although human error exists, it is minimal. Due to the many safeguards and precautions taken, the blood supply in America is safe. The risk of contracting a disease from the donation process is quite minimal and there are more reasons to give blood than not to give blood. It is my opinion that if a person can give blood, they should. Donating blood is noble, safe, and painless, and when blood is given, the donor gets a wonderful feeling of doing good for someone and can be confident that he or she may have saved a life. So when that little girl arrives at the hospital, unconscious and bleeding, she can be sure that the blood she receives will be safe. Works Cited The Blood Center of Southeastern Wisconsin, "Testing Performed on All Blood Donations" 5/96 2 The American Association of Blood Banks, " Recieving Blood" 1995 f:\12000 essays\health & humanities (196)\The TRUE Coldwar Our Battle with Diseases.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Plague. A word that has struck fear in the hearts of man since the earliest of times. It has also lead to some of the greatest historical events and stories of our time. The ancient cities of Rome and Athens, in their downfall, were finished off by pestilence. The Bubonic Plague, also known as The Black Death, devastated Europe in the 14th century, starting a new age. The great warrior Ivan the Terrible was stricken with disease, and driven mad. During the "exploration" of the new world, Cortes's greatest ally against the Aztecs was smallpox. Napoleon's Grand Army was defeated by the Russians, and typhus. Queen Victoria spread hemophilia to her heirs, leading to the illness of the only son of Czar Nicholas, and the fall of monarchy in Russia.1 All the events are horrible in every way, but have struck a chord with people around the world. Perhaps it is our inherent morbid curiosity. So, the question is, if these events happened once, why can't they happen again? Let us take a look at the most horrible, so far, of the plagues: The Black Death. It took Europe by storm from approximately 1345 to 1361. It would also make small comebacks throughout the next 400 years, but never like it did the first time. It also reached into Africa, China, Russia, and the Scandinavian countries. It was truly a worldwide pandemic. But, it has a secondary effect that not many people are aware of. The colonies of Greenland, settled by the Vikings, were stricken by the plague and they soon disappeared. It is known that these colonies kept in contact with "Vinland", which was near New Foundland, in Canada. The Vikings had already discovered North America! But, alas, with these colonies all dead, Greenland was forgotten, and not discovered again until 1585.2 It is estimated that the plague took 24 million lives, about a quarter of the European population. This may seem incredulous to people today, but it happened. During those times, where there were humans, there were black rats. And where there are rats, there are fleas. And where there were fleas, there was the plague. Bubonic plague, and also pneumonic plague, were everywhere. France, Italy, Russia, England, you name it. When a village was infected, people fled, most likely taking the plague with them to the next village.3 One can only imagine what the people of that time thought. In those days, the church was the controlling influence. So, they probably thought it was the wrath of god. And with wraths of god, comes the need to search for scapegoats. And the main scapegoats were the Jews. They were accused of infecting town wells, and spreading imaginary poisons from city to city. For these "crimes," they were burned, hung, stoned, etc. Also, specific scapegoats were found and killed in every city. Mass hysteria gripped the known world. Then, it slowed down. It didn't stop, and it wouldn't for many years, but it slowed down enough for society to get back on its feet. And society now had a new outlook on life. The all-powerful Catholic Church still wielded some power, but not what it previously had. Europe was ready for a change. So, if you're an optimist, you might say that the plague gave Europeans a fresh start.4 And while we are on the subject of the past, I shall relate another story of a strange disease and its effects on history. In the opening, I mentioned the destruction of Napoleon's Grand Army at the hands of typhus. Let's delve a little deeper into that event. In the spring of 1812, Napoleon had reached the height of his power and glory. His empire spread eastward to the Russian frontier and to Austria. Two of his brothers were kings. His 3 sisters all sat on thrones in one sense or another. His first son was Viceroy of Italy. And Napoleon himself was currently married to the great niece of Marie Antoninette, and their first child was immediately named King of Rome. Napoleon was on a roll.5 Given time, patience, and some luck, he might have been able to extend his empire to the East, and force those pesky British into isolation, cutting them off from any matters in Europe and Asia. But these dreams would go unresolved. Because of something Napoleon could not see.6 In June of 1812, in eastern Germany, Napoleon massed a force of 368,000 infantry, 80,000 cavalry, 1,100 guns, and 100,000 reserve infantry. He now outnumbered the Russian forces. With the Russian's defeat, Napoleon could boast being in control of most of Europe. But only 90,000 of the central army reached Moscow. And the rest was destroyed in the retreat. Why? As the Grand Army marched to Russia, they had to pass through Poland. Poland was filthy and dirty. Most of the army was undisciplined, and pillaged villages, making themselves sick in the process. In the third week of July, Napoleon had lost 80,000 men, most to disease, and some of those to typhus. Since typhus was transmitted through lice, soldiers could carry them on unwashed clothing without even knowing it. The Grand Army was a walking death trap.7 As typhus raged on, Napoleon was down to 130,000 men by September 5th. On the 14th of September, he was down to 90,000 men as he tried to seize Moscow. But he found Moscow empty as the citizens had fled, and the Russian army had marched south to cut off supplies. Napoleon received 15,000 more men, but 10,000 would end up dead as the "Grand" Army would have to retreat from Russia. By the time Napoleon's army returned, it was 25,000 weak. Less than 3,000 would be alive the following summer. Typhus had done its worse.8 "Okay," you're saying, "The only reason those things happened is because people lived with rats, and built dirt houses. This is the 90's! It can't happen now!" Oh yeah, now read this: Scientists can't stop everything that comes along. And you would be surprised what comes along. In the 60's and 70's of the 20th century, health officials figured they had beaten diseases. Smallpox, polio, tuberculosis, cholera, malaria; all were beaten or close to it. Humanity's deadliest enemies were nearly wiped off the Earth. Then, just 2 decades later, HIV, Ebola virus, Marburg virus, Lassa fever, Legionnaire's disease, hanta virus, hepatitis C, and more to come. Most of these scourges came from newly inhabited areas, like the rain forest. And then our underfunded prevention programs allowed TB, yellow fever, cholera, and even the plague to make a major comeback.9 So, are we defeated? Are diseases ready to make the kill? The fact is that they could, but the probability factor is low. The Center for Disease Control (CDC) works very hard to be prepared for anything. And if, lets say, Ebola virus broke out in Virginia (which it did), they would be on top of it in a second, quarantining the area, then trying to treat the people. The so-called "Hot Zone" in Virginia was contained. But what if it wasn't? What if it grew unchecked? Well then, contrary to what was portrayed in the movie Outbreak, our government would, in my opinion, totally destroy the area, most likely with the vacuum bomb, without a second thought. The president would give the orders, and they would be carried out. Be compassionate, but be compassionate globally would be the motto. And no one could disagree. Another question is, where are these diseases coming from? Well, as we explore the rain forests, or any previously uninhabited area, the risk is high that we will find something. Although it might be something we don't want to find. Hey, its happened before. When the white man first infiltrated Africa, he found tsete flies, malaria, and yellow fever just on the coast. As he tried to move inland, more killers emerged.10 In 1816, Captain James Tuckney tried to explore the River Congo. His expedition was attacked by fever and vomiting. 18 died. In 1832, Major A. M'Gregor Laird went to the Niger Delta. By the 12th of November, all men were down with fever. By the 14th, 1 of the men was fit for duty. 9 survived.11 In 1841, Cap. H.D. Trotter took 145 whites, and 158 blacks on a massive expedition to Niger on 2 boats. After all was said and done, every white was sick and 50 were dead. Not one black died. There were dozens more of these disastrous treks into Africa. The results of these trips, whites dying and blacks surviving, led to the erroneous medical belief that whites could not work without getting sick, so only blacks should work.12 This still lead to white deaths, but also racism. These treks usually ran into malaria, yellow fever, and sleeping sickness. And once these scourges were introduced to Europe and America, they couldn't be stopped, and ran unchecked for years. So now we are doing the same thing in the rainforests of Brazil.13 What was that old saying, if we don't learn from the past, we are doomed to repeat it? So, will mankind cause a great plague across the world? Maybe not. Let's look at a strange case of fever in late summer, 1968. A mystery disease struck at the Oakland Public Health Center in Pontiac, Michigan. Within 48 hours, 95% of the center's employees were sick. Patients and visitors also came down with it. The CDC sent two 3 man teams in......all 6 became sick.14 One week after all this started, the building was sealed off. Sick epidemiologists became well again and started to investigate. It was eventually decided that the disease was airborne.15 State experts came in and used special "vacuum" machines to suck the air for bacteria, and then took swabs of everything......negative. When the victims recovered, they returned to work. Some were stricken again, some not. "Pontiac Fever" was not highly communicable. About a month later, in August, precautions were relaxed, and a doctor investigating the disease, Dr. Gregg, took off his mask. He was promptly infected. After he recovered, he started studying rat and bird droppings in the center. Neither the CDC nor the MHD (Michigan Health Department) could suggest clues.16 Dr. Gregg rushed 90 lab animals, of which only the guinea pigs developed pneumonia. He then examined the pig's lungs, and found a bacteria that only could be cultured in egg yolk. Dr. Gregg now became convinced that the infection source was in the air- conditioning system. When he investigated the basement, and cut one of the ducts, he found a pool of filthy water. The dirty water was definitely the agent, although after 2 years, no specific infectious agent was found. Pontiac fever has not been seen since.17 We were lucky that Pontiac fever was not fatal. It was just a very bad kind of flu. Actually, the US army's biological warfare branch was very interested in finding out what caused the fever. Pontiac fever was non-fatal, fast-moving, and debilitating, just what the army likes. Although they like that, they wouldn't be above using something that was fatal. And that brings us to another killer......our government. Do you realize how much land the government owns out in California, Arizona, Oregon, etc.? I hope you do, because I don't. I can't seem to find it anywhere. Oh well, I say its too much. Most of that area is uninhabited and impossible to live on, so its a perfect spot to carry out little experiments that the American public wouldn't be to happy about. Do I know any of this? No, but I can voice my opinion. I say as long as the government keeps its little diseases out of my way, its okay with me. But, I fear if they are not careful, the American people will be feeling the breath of the Grim Reaper on their faces. And the Reaper doesn't brush regularly. For some reading on a subject like that, read Stephen King's The Stand. 1,000 pages of sheer brilliance, and an eerie prediction. So, let's say that the exotic jungle diseases never arise, the government keeps its secrets in its labs, and our scientists keep current diseases in check. We'll be safe, right? Wrong! Look at a "normal" disease we take for granted, like the flu, or pneumonia. Flu kills 2,000 a year, and pneumonia kills 65,000 a year, and that's just in this country. Pneumonia is extremely deadly when it infects both lungs, mostly killing people under 14 and over 75.18 Legionnaire's disease was a type of pneumonia that raged through the Legionnaire's convention in Philadelphia in 1976, killing people. And look at the flu. The flu comes in many different varieties, Types A, B, and C. In the early part of this century, the flu ran throughout the world, killing some 22 million people. That was Type A flu. Type B also causes epidemics, but mostly in schools. Type C is uncommon.19 And doctors are ineffective in treating the flu. A Type A vaccine won't protect you against Types B or C, and new types of A and B emerge each year. And scientists are waiting for the next big flu pandemic to sweep the world. They know it's coming, and it's coming soon. Hey, it could even be this year. Flu pandemics usually start somewhere in January or February. So, next time you come down with a case of coughs and the chills, watch out. You may be in the middle of a epidemic.20 Well, by this time you're probably feeling very depressed, and maybe a little paranoid. Good, my work is going well. And I'm not done yet. Now that I've run down specific incidents and possible incidents, let's take a look at statistics for diseases that are curable! Cholera kills 120,000 a year. Diphtheria kills 8,000. Hepatitis C infects 100 million. Malaria kills 2.7 million a year. Tuberculosis infects 22 million worldwide.21 What are we doing? Not a very good job, I'll wager. If we can't stop diseases that can be stopped, what are we to do about ones that we can't? It's like letting the little kid beat you up because you feel sorry for him. Well, my journey through the darkest of man's fears is done. I have gone into the pits of hell and come out unscathed. Actually, I haven't, but it sure does sound good. I hope to have entertained you through this paper, and given you something to chew on for a few weeks. And I have just one more thought. When people think of the end of the world, they think of a big mushroom cloud destroying everyone in a pillar of light. But, I just don't see that. I see something less spectacular. When the end comes, it won't be with a bang. No one will see it coming. An army of the smallest soldiers will attack us from the inside out. One-billionth of our size, and they'll beat us. BIBLIOGRAPHY 1. Abel, Ernest L. America's Top 25 Killers. Hillside, N.J.: Enslow Publishers Inc., 1991 2. Archer, Jules. Epidemic! New York: Harcourt Brace Jovanich, 1977. 3. Berger, Melvin. Disease Detectives. New York: Thomas Y. Crowell, 1978. 4. Cartwright, Fred F. Disease and History. New York: Thomas Y. Crowell, 1972. 5. Guerrilla Warfare. "Time: Frontiers of Medicine." Vol. 148, No.4, Pg. 58-62. 6. McNeill, William H. Plagues and Peoples. New York: Anchor Press/Doubleday, 1976. f:\12000 essays\health & humanities (196)\The use of Merit Pay Scales as Incentives in Health Care.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ The purpose of this paper is to explore the use of Merit Pay and Incentives as motivators for increased productivity. The key focus is the system at Richmond Memorial Hospital. To do so, one must begin at the beginning..... The use of financial incentives (financial rewards) paid to workers whose production exceeds some predetermined standard was popularized by Frederick Taylor in the late 1800s. As a supervisory employee of the Midvale Steel Company, he had become concerned with what he called "systematic soldiering". This was the tendency of employees to work at the slowest pace possible and the fact that some of these same workers still had the energy to run home and work on their cabins, even after a hard 12-hour day. Taylor knew that if he could find some way to harness this energy during the workday, huge productivity gains would be achieved (REFERENCE?). Thus was born the concept of motivational and incentive systems. What is "motivation?" The root word is "move" which would mean that anyone who is moved to do something is motivated. Therefore, sitting on a tack, or at least the pain associated with it is a motivator. For those of us in Graduate School, we are aware that without a "B" average we will be eliminated from the program. Maintaining that average is our motivator. Attaining the certificate of graduation is our incentive. In psychology, at its most basic, a motivator is that which impels or compels an individual to act toward meeting a need. On a physiological level, thirst, hunger and sex are motivators or drives. They are basic needs which must be met. Relating this to a hospital environment, it is not base compensation which drives the employee, but what the base compensation can satisfy in a higher level of needs. Money can't buy love, but it can buy some security such as insurance benefits. After basic and security needs are met, compensation is not the motivator, but what compensation represents is (REFERENCE?). One statement that must be made before continuing is that needs are varied and can occur concurrently or over a period of hours or days, etc. And, needs are mixed. Hunger is a drive: The satisfaction of hunger can take several forms and, usually, when one is hungry one also is a little thirsty. Then, if the book, Tom Jones (AUTHOR, YEAR), was any indicator, food and drink enhance the sexual drive ((MAY NEED TO TELL A BIT ABOUT THE PREMISE OF THE STORY AND HOW IT RELATES IN CASE SHE HASN'T READ IT). Sooner or later, one has to rest...and so it goes. But, do note that a number of needs or motivators may be "acting" at the same time. In hospital settings, especially those that are undergoing restructuring needs are highly varied. The same employee who is driven by a salary motivator may now be driven by a long term security need as a motivator (REFERENCES??). Many times, if one is given a bonus for a job well done, the money is not the motivator, but the recognition is. Initial motivation can occur with the use of bonus or profit sharing. However since bonuses and other such incentive compensations occur perhaps as little as once a year, there must be other motivators at work to get an individual to work towards established goals. This is an important concept which must be understood in order to have any incentive compensation system work for the company and individuals (REFERENCES???). Implementing pay for performance plans, good management, and incentive plans will motivate personnel to perform at the peak levels necessary to bring about improvement in the bottom line which is what interests most corporations (REFERENCE?). With flatter organizations, and in most cases fewer employees, companies need to motivate their remaining employees to make a value-added contribution, take ownership, and be held accountable for their work (REFERENCE?). Historically, employees have been rewarded with increased base pay, promotions, and titles (REFERENCE?). However, organizations today are finding other means of motivating employees. Companies are recognizing the need to change their pay philosophies, from paying for position or title to paying for people. In accordance with this changed philosophy, and increasing number of organizations have taken the step of truly linking pay to performance, through such programs as variable pay, where a percentage of pay is "at risk," depending on the employee's achievement of predetermined measurable production, operations, or other goals (REFERENCES??). Merit pay systems which are based on past performance are flawed by their very nature and do not work effectively as a reward system. These systems provide a supervisor with a means of escape from the proper practice of their authorities, accountabilities, and leadership to subordinates. The merit pay system depends on the reward to produce the effect rather than planning and designing the effect at the outset (REFERENCES??). Presently, this (THIS MEANING WHAT?) is a system that is used at RMH under the title of Management by Development (MBD), Appendix I. This (WHICH SYSTEM?) system supposedly evaluates employees on various aspects of their professions. The evaluation encompasses a personal evaluation by scoring on particular items separately by the employee and supervisor. Finally a meeting is held in which both the employee and supervisor come to agreement over each score and discuss any variances. Once the final score is determined, a mathematical equation is instituted and from that equation is derived a percentage that is applied to the employees' base salary. The percentages range from 1 to 10 percent (REFERENCE?). It is common knowledge among employees at Richmond Memorial Hospital that the percentages are manipulated by supervisors to keep salaries within departmental budget goals. This means of evaluation has created an environment of generalized apathy amongst employees. Employees have to be coaxed repeatedly to complete their portion of the MBD even though it will result in increased pay. No one wants to spend hours evaluating their own performance to achieve a presumed 3% raise. The MBD further shackles (WONDERFUL VERB!!) the employee and the supervisor by requiring documentation for any score above average. As managers, it has been our experience that when one is presented with ten evaluations and documentation is required on all ten, it is easier to just rate the person as average and not have to provide so much documentation. According to Dressler(1994), some supervisors grade more stringently than others, some truly have mostly stars (SUPERVISORS OR EMPLOYEES?? WHO IS SOME?), and others are subject to the traditional rating errors. There is also the problem that if there is very little difference in ratings, then superior performers are not receiving the appropriate reinforcement, and poor performers are not being given clear expectations of what they must do in order to improve. This (WHAT?) is what results when the percentages of the MBD are manipulated for budget goals and the majority of employees end up with a 3% raise even though the range is from 1 to 10 percent. Cleaning up these problems may be a prerequisite for installation of an effective incentive plan. The confusion between reward for past performance and promise to pay for future performance undermines the integrity of the employees role (REFERENCES?). Linking pay increases overtly to future performance and the companies requirements for work of a given complexity (i.e., Registered Nurse, Licensed Practical Nurse, Respiratory Therapist, Administrative Assoicate or Technical Associate) removes the confusion from the merit pay system. It puts accountability where it should have been in the first place, with the employee (REFERENCES?). In accordance with this changed philosophy, an increasing number of organizations have taken the step of truly linking pay for performance, through such programs as variable pay, where a percentage of pay is at risk, depending on the employee's achievement of predetermined measurable goals (Dressler, 1994). The basic characteristic of all of these at risk pay plans is that some portion of the employees base salary is at risk. In the Dupont plan, for instance, the employees at risk pya is a maximum of 6 percent. This means each employees base pay will be 94 percent of his or her counterparts salary in other "non at risk" Dupont department (REFERENCE?? NEED PAGE NUMBER FOR DIRECT QUOTE). At Saturn, the at risk component was initially designed to be about 20 percent but was recently cut back to 5 percent. The at risk approach is aimed in part at paying employees more like they are partners. It (WHAT IS?) is actually similar to much more extensive programs in Japan in which the at risk portion might be 50 to 60 percen tof a persons yearly pay. To the extent that at risk pay is part of a more comprehensive program aimed at turning employees into committee partners-programs stressing values of trust and respect, extensive communications, and participation and opportuniites for advancement, for instance-at risk programs should be successful (REFERENCES?). Dressler (1994) also discusses the following types (ONLY ONE TYPE LISTED FOLLOWED BY INCOMPLETE SENTENCE) of pay programs: Merit Programs which all salaried employees receive merit salary increases based on their individual performance. As opposed to automatic step progression. The performance appraisal process at Federal Express provides the vehicle for rating employees performance and for sharing that information for the individuals development and making pay increase recommendations based on sustained performance (REFERENCE?). Another type of pay system is Pro-Pay where employees can receive lump sum merit bonuses once they reach the top of their pay range and is only paid for above average performance (REFERENCE?). Star/Superstar programs are where employees who represent the top ten percent of performers receive lump sum bonuses. Along with a Pay for Performance system, there must also be in place a incentive system. (Grossman, YEAR?). Pay perform & prod (next lines) (INCOMPLETE SENTENCE) "Many US business owners are finding that turning to incentive programs is a good way to boost productivity and improve morale" (REFERENCE- NEED PAGE NUMBER FOR DIRECT QUOTE).. A properly structured incentive-driven system (IDS) provides several methods and levels of compensation. All IDS systems must be tailored to each organization. What works in a hospital may not work in academia (Dressler, YEAR?). It is usually a mistake to implement an incentive plan without input from employees. Management should use a program design team composed of employees and supervisors. They could work with Human Resources in the development of f:\12000 essays\health & humanities (196)\Therapeutic Touch.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Therapeutic Touch 1 INTRODUCTION Therapeutic touch has been shown to decrease patients anxiety levels and increase their pain tolerance levels when other more mainstream therapies have not been completely effective. "Therapeutic touch is a process by which energy is transmitted from one person to another for the purpose of potentiating the healing process of one who is ill or injured." (Heidt, 1981; Krieger, 1979; Lionberger, 1985; Randolph, 1984; Kramer, 1990). In my capacity as a nursing student on a medical- surgical unit, I have noticed an increase in pain medication requests among patients with incision site pain and a minimal use of alternative therapies for this pain management. With the use of therapeutic touch nurses can regain a closeness with patients and also have a direct effect on their pain level. Therefore the purpose of this study will be to determine if therapeutic touch is an effective intervention for patients experiencing surgical incision site pain within the first forty-eight hours after surgery. PROBLEM STATEMENT The question posed for study is: "Is therapeutic touch an effective intervention for decreasing a patients surgical site pain within the first forty-eight hours after surgery?". The independent variable is therapeutic touch. The dependant variable is decreasing surgical site pain. The population to be studied will be patients on a thirty bed medical-surgical floor of a Lake Charles hospital. Fifty surgical patients will be studied over a four week period. The patients will be randomly selected to avoid any bias by the researcher. SIGNIFICANCE OF THE PROBLEM "... therapeutic touch is a nursing intervention that has the potential for eliciting a state of physiological relaxation in patients and for decreasing patients anxiety" (Heidt, 1991). The use Therapeutic Touch 2 of therapeutic touch is very important to the nursing community. The need for immediate intervention in acute or chronic pain could be handled at the bedside with no need to await a doctor's order for pharmacological intervention. Anxiety could be lessened to let patients rest more comfortably in the stressful hospital environment. Also teaching could be enhanced in the less anxious and more pain free client. A client that is admitted to the hospital for surgery may not get all the rest needed for proper recovery and healing due to inadequate pain relief from pharmacologic interventions. The need for more in depth research and application in the field of therapeutic touch as a nursing intervention is essential. REVIEW OF LITERATURE In preparing to undertake this research, various forms of literature must be examined. In a study done by Nancy Ann Kramer, MSN, RN on therapeutic touch and casual touch stress reduction of hospitalized children (1990), her study supported the use of therapeutic touch. She states "... the intervention of therapeutic touch will more quickly reduce the child's stress and provide comfort for a longer time, which eventually may decrease the hospital stay and decrease nursing work.". The author states that more research may need to be done with a larger sample and a wider range of patient stressors to further support the use of therapeutic touch in a clinical setting. She used a sample of thirty children ages two weeks to two years old. In the next study, done by Patricia R. Heidt, RN, PhD, "Helping patients to rest: Clinical studies in therapeutic touch"(1991), she studied patients who wanted help with pain relief. Her main reason for this was to increase the "descriptive data on patient care" so further research could be done and therapeutic touch could be applied in nursing interventions. The strength of this study came from its in depth look at two case studies and how the therapeutic touch was Therapeutic Touch 3 used on two specific patients. The case studies gave an in depth look at the patients history and treatment and out comes after therapeutic touch was used. It also explained the settings and exactly what was done step-by-step through the therapeutic touch treatment by Heidt herself. The weakness of this study was also its strength. It had a very narrow focus and was not applied to a large group. In a study, done by Janet F. Quinn, RN, PhD, FAAN and Anthony J. Strelkauskas, PhD, named "Psychoimmunologic effects of therapeutic touch on practitioners and recently bereaved recipients: A pilot study"(1993), they wanted to identify the variations and "address conceptual inconsistencies...in previous Therapeutic Touch research...". The study was done with two therapeutic touch practitioners and four recently bereaved patients. They wanted to determine if there was a correlation between who received the therapeutic touch and who applied the therapeutic touch. Their study supported the use of therapeutic touch on practitioners and others who are bereaved and how therapeutic touch can increase white blood cell response. The weaknesses of this study were: that a short time frame was used (two weeks) and a small sample of practitioners and recipients was used. The strength of this study flowed from its use of descriptive language and its ease of obtaining bereaved subjects for use in the study. In the following study, " Effects of Therapeutic Touch on Tension Headache Pain" (1986), done by Elizabeth Keller and Virginia M. Bzdek they reviewed a sample of sixty volunteers from ages eighteen to fifty-nine that experience tension headaches. Their study supported the use of therapeutic touch in tension headache pain. They used a large sample population and various testing components for grading pain and relief of pain. I find this to be the strength of this study. A weakness of this study was its non-use of any pharmacological Therapeutic Touch 4 intervention and also the total subjectiveness of a person's pain rating. It also did not rule out whether any of the subjects had ever previously tried alternative therapies for their headache pain. In summary, the results of the literature seem to support that therapeutic touch is an effective intervention, whether for pain, stress, or anxiety. The literature also suggests that use of therapeutic touch can aid in recovery of a patient's physiological and psychological homeostasis. The literature reviewed has set the base for the proposed study: To determine if therapeutic touch is an effective nursing intervention for surgical site pain in the hospitalized patient. CONCEPTUAL FRAMEWORK Rogers' model of the unitary person provided the theoretical framework for this study. "Rogers' model (1986) focuses on the individual as a unified whole in constant interaction with the environment. The unitary person is viewed as an energy field that is more than, as well as different from, the sum of the biologic, physical, social, and psychological parts." (Polit and Hungler , 1993). Therapeutic touch allows the patient to be seen as "more than a sum of the parts". The use of therapeutic touch gives the patient an alternate course of treatment when others have failed or are ill suited for other interventions such as intramuscular narcotics due to allergies or increased risk of infection. Therapeutic touch is said to work with the interaction between energy fields of the healer and patient. When an incision is made into a person's body, it disrupts this energy field. A nurse with experience in therapeutic touch could help rectify this disruption and "...help people achieve maximum well-being within their potential." (Polit and Therapeutic Touch 5 Hungler, 1993). RESEARCH HYPOTHESIS 1. There is a relationship between the use of therapeutic touch on a patient with incisional site pain and decrease in the use of narcotic analgesia. METHOD The sample will be taken from a thirty bed medical-surgical floor of a Lake Charles, Louisiana hospital. Fifty surgical patients will be studied over a four week period. Inclusion criteria: all the subjects must have an incisional site and be on some prescribed narcotic analgesia for pain relief. They must be able to rate their incisional pain verbally on a scale of one to ten with ten being the most excruciating pain they ever felt in their life and zero being no pain at all. Twenty-five patients will be given a placebo therapeutic touch treatment within five minutes of their request for pain medication. The treatment will last for five minutes then the patient will be asked to rate their pain level again. Next, the prescribed analgesia will be given and the patient's pain level will be assessed again in thirty minutes. Twenty-five patients will receive the actual therapeutic touch treatment within five minutes of their request for pain medication. The treatment will last for five minutes and then the patients will be asked to rate their pain level again. The prescribed analgesia will then be administered, and the patient's pain level again will be assessed in thirty minutes. In both groups no actual physical contact will be made. Deep breathing and a quiet atmosphere will be required with both groups. Neither group will know whether they are the placebo or actual therapeutic group. They will be assigned by using a random selection table. Therapeutic Touch 6 All participants will be required to sign a written informed consent form. This will include the stipulation that if at any time they do not want to participate in this study, then they may remove themselves from it. DEFINITIONS "Therapeutic touch is an intervention that is a derivative of laying-on of hands, during which it is assumed that the practitioner knowingly participates in the repatterning of the recipient's energy field for the purpose of helping or healing the person. In treating a person with therapeutic touch, the practitioner: makes the intention mentally to therapeutically assist the subject; moves the hands over the body of the subject from head to feet, attuning to the condition of the subject by becoming aware of changes in sensory cues in the hands; redirects areas of accumulated tension in the subject's energy field by movement of the hands; and focuses attention on the specific direction of energies to the subject using the hands as focal points. " (Quinn and Strelkauskas, 1993). The pain rating scale to be used will consist of numbers zero to ten with ten being the most excruciating pain ever felt by the subject and zero being no pain at all. Since pain and this scale are both subjective in nature, their validity and reliability are compromised. The pain rating scale is defined as the following: *0-2 No therapeutic intervention needed relate to a mild headache *2-5 Mild analgesia needed for pain relief equivilent to two Tylenol for pain relief *5-7 Medical intervention required for adequate pain relief, oral narcotics *7-10 Strong narcotic analgesic needed for pain relief, intraveneous or intramuscular administration Therapeutic Touch 7 RESEARCH DESIGN The design used for this study will be a before- after design. It will study the subjects' level of pain before the use of therapeutic touch, after therapeutic touch treatment, and also after the use of a narcotic analgesia. The reason for selecting this design is its simplicity. Half of the fifty patients will be randomly chosen as a control group. Observation of the dependant variable will be taken at those points in time as listed above. It will allow us to examine the changes of the patients response before and after the therapeutic touch treatment. SAMPLE The study subjects will be fifty surgical patients from a thirty bed medical-surgical floor at a Lake Charles hospital over a four week period. Each patient will have to meet the following criteria for the study: 1. The patient must have experienced an uncomplicated surgery. 2. The patient must have a surgical incision of at least two inches in length. 3. The patient must have some narcotic analgesia ordered for post-operative pain control. 4. The patient must be admitted into the hospital for a stay of greater than forty-eight hours after surgery. 5. The patient must sign a consent form to participate in the study. 6. The patient must be between the age of eighteen and thirty years old. The sample will include both male and female subjects. The nursing staff will identify candidates for this study when admitted to the post-operative surgery floor from the post- anesthesia care unit. If the patient cannot read the staff can read the consent to the patient. After Therapeutic Touch 8 verbalizing understanding of the consent, the staff member and one witness can sign the consent form for the patient. If the patient meets this criteria noted above they will be asked to sign a consent to participate in the study. HUMAN RIGHTS PROTECTION Freedom from harm will be assured by the giving of pain medication promptly after the therapeutic touch treatment. The nurse will respond within five minutes with the therapeutic touch treatment that will last five minutes. If the patient still requests pain medication after the therapeutic touch treatment, it will be administered. If at any time the patient cannot wait for the narcotic analgesic until after the therapeutic touch treatment, it shall be administered. This will effectively remove the subject from this study. The subjects will have the benefits of this study explained to them before participating in it. The risks are minimal as all that will be introduced is the therapeutic touch treatment. The use of narcotic analgesia will still be an option for the patient and will not be withheld if asked for before the therapeutic touch treatment is over. The benefit of this study will be enhanced knowledge for the use of pain management without or in conjunction with pharmacological measures in the post-operative period. The subjects will have the right to decide to join the study voluntarily. There will be no penalties or prejudicial treatment for not joining the study or for leaving the study at any time before it is over. The subjects will have full knowledge of the study to be performed and will have to sign a consent from which will include the following: "*The fact that the data provided by or obtained from the subjects will be used in a Therapeutic Touch 9 scientific study *The purpose of the study *The type of data to be collected *The nature and extent of the subjects' time commitment *The procedures to be followed in collecting the research data *How subjects came to be selected *Potential physical or emotional discomforts or side effects *If injury is possible, an explanation of any medical treatments that might be available *Potential benefits to subjects (including whether or not a stipend is being offered) and potential benefits to others *A description of the voluntary nature of participation and the right to withdraw at any time without penalty *A pledge that the subjects' privacy will at all times be protected *The names of people to contact for information or complaints about the study". (Polit and Hungler 1993) SUMMARY The use of therapeutic touch treatment in a clinical setting is a growing trend all over the world today. Therapeutic touch was derived from many ancient healing arts. In its contemporary form, therapeutic touch was developed by Dolores Krieger, Ph.D., RN., and her mentor, Dora Kinz, in the early 1970s. Research has shown that therapeutic touch is effective in promoting relaxation and reducing anxiety; changing the patients perception of pain; and in restoring the body's natural Therapeutic Touch 10 processes. The importance of therapeutic touch to nursing is tremendous. Nurses must use a holistic approach to healing. The only way to succeed with this is by using all the tools that can be used. Therapeutic touch is being supported and taught in many nursing schools in Canada. It is put into practice in a wide range of settings from nursing homes to stress reduction of the nursing staff themselves to reduce "burnout". Research indicates that therapeutic touch does produce significant levels of effective healing. The continued research in therapeutic touch and its use is essential. Therapeutic Touch 11 REFERENCES Heidt, P.R. RN,PhD, (1980). Effect of therapeutic touch on anxiety level of hospitalized patients. Nursing Research, 30, (1), 32-37. Heidt, P.R. RN,PhD, (1991). Helping patients to rest: Clinical studies in therapeutic touch. Holistic Nursing Practice, 5, (4), 57-66. Hill, L. PhD, RN, Oliver, N., PhD, RN., (1993). Therapeutic touch and theory-based mental health nursing. Journal of Psychosocial Nursing, 31, (2), 19-22. Keller, E., MSN,RN-C, Bzdek, V.M., PhD, RN, (1986). Effects of therapeutic touch on tension headache pain. Nursing Research, 35, (2), 101-106. Kramer, N.A., MSN, RN, (1990). Comparison of therapeutic touch and casual touch in stress reduction of hospitalized children. Pediatric Nursing, 16, (5), 483-485. Mathews, K.M., RN, MN, SCM, (1991). Mothers' satisfaction with their neonates' breast feeding behaviors. Journal of Gynecological and Neonatal Nursing, 20, (1), 48-55. Polit, D.F., PhD, Hungler, B.P., RN,PhD, (1993). Essentials of nursing research methods, appraisal, and utilization (3rd ed.). Philadelphia: J.B. Lippincott company. Publication manual of the american psychological association (6th ed.). (1995). Washington D.C.: American Psychological Association. Quinn, J.F., RN, PhD, FAAN, Strelkauskas, A.J., PhD, (1993). Psychoimmunologic effects of therapeutic touch on practitioners and recently bereaved recipients: A pilot study. Advances in Nursing Science, 15, (4), 13-26. Therapeutic touch : its effectiveness on surgical incision site pain December 2, 1996 f:\12000 essays\health & humanities (196)\Tobacco Advertising and its Effects on Young Adults.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Ryan Sharp English 10 Tobacco Advertising and its Effects on Young People. In this world there are many injustices that deal with our children. A main injustice is the advertising of tobacco directed to our youths. Every day 3,000 children start smoking, most of them between the ages of 10 and 18. These kids account for 90 percent of all new smokers. In fact, 90 percent of all adults state that they first start smoking as a teenager. The statistics clearly show that young people are the prime targets of tobacco sales. The head of these media companies are Marlboro and Camel. Marlboro uses a western character known as The Marlboro Man, and Camel uses the "smooth character" Joe Camel. Joe Camel who is shown as a camel with complete style has been attacked by many Tobacco-Free Kids organizations as a major influence on the children of America. Researchers at the Medical College of Georgia report that almost as many 6-year olds recognize Joe Camel as they do Mickey Mouse. That is very shocking information for any parent to hear. Children are attracted by these advertisements because they like cartoons, and they think that a cartoon is harmless and what the cartoon does is harmless too. There is so much cigarette advertising out there a child is sure to be struck by its attention. The companies deny that these symbols target people under 21 and claim that their advertising goal is simply to promote brand switching. Illinois Rep. Richard Durbin disagrees with this statement stating "If we can reduce the number of young smokers, the tobacco companies will be in trouble and they know it". The companies go toward a market that is not fully aware of the harm that cigarettes are capable of to keep their industry alive and well. When kids were asked why they started smoking, they gave two contradictory reasons: They wanted to be a part of the crowd. Children don't want to be left out, they want to be wanted. If their peers are smoking then they will want to smoke too. They also wanted to reach out and rebel at the same time. When children are told over and over by more authoritative people not to do something, then they are going to do it. They do this just to get back at the authorities or to satisfy their curiosity. Teens also think of smoking as a sign of independence. The surprising thing is that these kids know that they are being influenced by cigarette advertising. Here are three things on how to stop the future of America from smoking. Try to convince your children that smoking is not cool. If a child is talked to by there parents then they will listen to what they have to say. Talk to your kids at a young age about the dangers of smoking. If children are informed of the dangers cigarettes provide then they will prevent themselves from smoking. Identify family members who smoke and ask them to quit. If children are not around the habit then they won't have a reason to pick it up. Children are the most valuable assets we are given in life. Let's try to educate them while they're young to be independent thinkers and to not be swayed by the tobacco companies who are trying to take advantage of their mind and body. f:\12000 essays\health & humanities (196)\Treaing Diabetes.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Treating Diabetes with Transplanted Cells Seventy-five years ago the type of diabetes that affected children and young adults was lethal. In the 1990¹s investigators found that a hormone, that was produced in Islets of Langerhans, was not being produced in diabetes patients. This hormone, called insulin, enables other cells to take up sugar glucose from the blood for energy. Diabetes patients who were not making insulin had glucose from food accumulating in the blood while other tissues were starving. Their are two types of diabetes. Type 1 diabetes has ceased completely from making insulin and the people who had this kind usually died. Type 2 diabetes still makes a little insulin so suffers of this type usually lived. In the 1920¹s prospects for people who suffered from type 1 diabetes increased when it was learned that insulin extracted from animals and placed in humans could prevent death. Unfortunately, this is not a cure. Patients can get potentially fatal diabetes-related disorders. These include blindness and, or kidney failure. Atherososclerosis, numbness and pain in extremities caused by narrowed vessicles, may also be a problem. These effects are caused because insulin injections can¹t perfectly mimic naturally made insulin. That¹s why a therapy that maintains glucose values within normal from the begging is needed. An ideal treatment would be the implantation of islets. This, in theory, would only have to be done once and would insure proper insulin production. Successful grafts would also prevent diabete-related ills. At Paul E. Lacy¹s lab, experiments have been done for twenty- five years on such a process. At first they were just trying to understand the mechanics of hormone secretion. To start this they needed a way to separate islet clusters from the pancreas. These constitute only 2% of the entire pancreas, though, and are scattered throughout it. In 1967 they found a solution and took the islets from rats. These islets were transplanted in inbred rats to see if it would control insulin production in diabetes patients. It was a success and kept blood sugar levels normal. It even fixed early complications in the eyes and the kidneys. The next step was to test the process on humans. Unfortunately, the process that was used to separate rat islets from the pancreas did not work on humans. They had to find a new way to solve the problem. The problem took a few years to solve but in the mid 1980¹s they finally found a semi-automatic method to do it. This method managed to isolate 400,000 islets from the pancreas. It would take just the amount they estimated to maintain the blood sugar level. In 1986 the first experiment started. A lot of immune-suppresent drugs are needed so the foreign tissue would not be rejected. These drugs are risky, though, so the experiment was performed on patients who have had kidney transplants and are already on these drugs. They decided that the best place to place the islets was into the portal vein leading to the pancreas. This would give the islets nourishment from the beginning and would be less risky than placing them directly into the pancreas. The results were encouraging. Subjects were given 400,000 islets and the grafts worked. But it was not enough to stop insulin injection. Later when the islets were increased to 800,000, the insulin injections were able to be stopped, at least for a time. They also learned that the islets could be frozen and stored. Since 1990 about 145 patients have had the process done. Most were unable to control the blood sugar level. Strain on the islets may have been a problem and in some cases enough probably weren¹t used. Doctors are proposing to give these transplants with graphs even though the results weren¹t perfect. The process is less costly and easier than complete pancreas transplantation. Many concepts have been considered though to solve the last part of the problem. One is being looked into by Kevin J. Lafferty. That is, that if you destroy passenger luekocytes, the tissue would not be rejected.This has been attributed to the theory that it takes two signals for host white blood cells to attack foreign agents. These two signals are sent by the passenger luekocytes. Unfortunately, to destroy these luekocytes you also destroy the hormone-producing cells. Joseph M. Davie has devised a culturing technique, though, that kills the passenger luekocytes without hurting the hormone-producing cells. He placed 1,500 treated islets from one rat strain to a portal vein of another. There was no rejection! Unfortunately, the individual islets had to be treated separately and so is not practical for humans who need much, much more islets. A solution was found in 1993. It is to take a few treated islets to a subject. This creates a tolerance for these islets which are transplanted untreated later. This is still being experimented on, though. Another process is being experimented on also. This is being tried because of the theory that diabetes is caused by an autoimmune process that differs from rejection. This process perceives beta cells, specific cells that produce insulin, as foreign tissue and destroy them. Therefore even if a transplant is fully successful the bets cells will be destroyed. To cure diabetes, islets that do not match those of the recipients islets must be injected. Another solution is also to enclose these islets in a semipermeable plastic membrane. If pore size is ideal, membranes let glucose reach islets and allow insulin to made while keeping the islet safe. William L. Chick developed a technique that puts islets in a plastic tube that allows blood flow in where it contacts the islets. Then insulin passes out. It worked for a while until the tube became clogged. The biocompatibility has been improved, though, and has worked for several months in a dog specimen. These tubes are thought to be able to rupture though in a rough situation. This could cause internal bleeding. The tubes could also clog arteries. Franklin Lim and Anthony M. Sun has also prepared islets by suspending them in alginate and enclosing them. It has been placed in rats and worked but the islets died from lack of nutrients caused by the alginate. Plastic-coated droplets are more biocampatible and have temporarily reversed diabetes in patients. These capsules are very small but are needed in such large amounts that to be feasibly worked they would have to be even smaller. A way to remove these capsules readily is also needed. Paul E. Lacy has also developed a way using islets covered in jelled alginate and then enclosed in a hollow, semi spherical acrylic fiber that has amazingly biocompatibility. This procedure maintained normal blood sugar level in a rat for an entire year. It is being tested on humans. Research is also going on to make a fully artificial pancreas. This device would be able to monitor blood sugar and release just the right amount of insulin in response. A device that is at once small, durable and accurate is still trying to be devised though. Before these a solution can be wide spread used though, enough donor islets must be found beside cadavers due to the amount of people that suffer from diabetes. Some other places islets might be found are in fetuses, many scientists hope to find a way to implant insulin-making cells alone which can be grown in labs, and pig islets are also a major possibility. Transplanting of encapsuled cells may also help a lot of other people beside diabetes patients including; Hemophiliacs and people suffering from Parkinsons disease. f:\12000 essays\health & humanities (196)\Treating Anaphylaxis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Research Paper Paramedic Procedures I - Fall 1996 11/3/96 TREATING ANAPHYLAXIS In the emergency setting, anaphylaxis is a dangerous, life threatening condition that must be treated in an aggressive and timely fashion. Anaphylaxis is a condition related to acute allergic reactions. Following the body's exposure to the offending allergen, there are common systemic reactions. The most serious reactions involve the respiratory and cardiovascular systems, but the gastrointestinal, dermatologic, and genitourinary systems are often involved causing varied symptoms such as urticaria, flushing, angioedema, bronchospasm, hypotension, cardiac arrythmias, nausea, intestinal cramps, pruritus, and finally uterine cramps. (Physician Assistant, 8/94) The above list is by no means exhaustive, specific symptoms vary from person to person. The same person suffering from several anaphylactic reactions can also present with differing symptoms. Physiologically speaking, the two main effects of the body's released mediators (IgE) during an anaphylactic reaction are smooth muscle contraction and vasodilatation, which cause most of the body's adverse symptoms. (JAMA, 11/26/82) Since the most life threatening reactions usually involve the respiratory and cardiovascular systems, that is where emergency treatment is focused. In the cardiovascular system, a combination of vasodilatation, increased vascular permeability, tachcycardia, and arrhythmias can lead to severe hypotension. In the respiratory system, the swelling of tissues along with bronchospasm and increased mucus production are the main cause of death. So, if untreated, anaphylaxis can be fatal as a result of the body's going into what is essentially shock, while simultaneously (and more importantly) being deprived of the oxygen needed to sustain life. As of today there is one universally accepted treatment for acute anaphylaxis. Epinephrine. Epinephrine is both an alpha and a beta agonist. This makes it the drug optimally suited to treat anaphylaxis. "Epinephrine will increase vascular resistance, reduce vascular permeability, produce bronchodilation and increase cardiac output." (Emergency, 10/93) Epinephrine will directly counteract the potentially life threatening aspects of anaphylaxis. Epinephrine can , and is, used in the both the pre-hospital environment as well as in definitive care institutions. Epinephrine is widely administered by ALS providers the world over. The drug is so effective that and relatively simple to use that "...subcutaneous administration of epinephrine by EMT-B's trained in recognition ... of anaphylaxis... is safe." (Annals of Emergency Medicine, 6/95) Following the administration of epinephrine, antihistamines such as diphenhydramine, hydroxyzine, and promethazine can be administered. These agents block the harmful effects of histamine, a mediator associated with allergic reactions, and while not displacing histamine from receptors, they compete with histamine for receptor cites and therefore block additional histamine from binding. (JEMS, 4/95) Patients taking beta adrenergic blocking agents will have limited benefits from the administration of epinephrine (it being a beta agent), as well potentially unopposed alpha adrenergic effects that could result in severe hypertension. (Physician Assistant, 8/94) In such cases norepinepherine and dopamine may be necessary to treat systemic anaphylaxis. Glucagon which increases cAMP, is a bronchodilator, and stimulates cardiac output, can be very useful, even in the presence of beta blockers. (Physician Assistant, 8/94) Inhaled bronchodilators are useful for the treatment of respiratory complications associated with anaphylaxis. There is a wide variety of acceptable agents. Sympathomimetics such as albuterol, and metaproterenol will relax the smooth muscle in the respiratory tract. Anticholinergic agents such as ipratropium bromide can also decrease bronchospasm. Aminophylline, a bronchodilator and diuretic can also increase intracellular cAMP levels, as well as potentiating catecholamines and stimulating their release; these effects make it a useful tool in dealing with persistent bronchospasm. (Physician Assistant, 8/94) Even though steroids (glucocorticosteroids) have some potentially beneficial effects for the relief of bronchospasm and hypotension, they are not recommended for the treatment of acute anaphylactic symptoms due to the fact that it takes four to six hours for them to be effective. (JAMA, 11/26/82) But, steroids such as methylprednisolone and hydrocortisone, are useful in shortening the duration of, and reducing the severity of prolonged anaphylactic reactions, as well as preventing the recurrence of delayed symptoms. (Physician Assistant, 8/94) The above agents are all widely used to treat anaphylaxis. But there are studies and experiments underway that are looking at alternative, or additional treatments. Naloxone and thyrotropin-releasing hormone (TRH) are both being looked at in the possible treatment of anaphylaxis as well as traumatic shock. "Naloxone improves cardiovascular function in a variety of animal models of shock caused by...and anaphylaxis. Administration of TRH ...also has pressor effects in these shock models." (Annals of Emergency Medicine, 8/85) "TRH has been shown to increase mean arterial pressure during anaphylactic shock." (Annals of Emergency Medicine, 5/89) In animal studies of anaphylaxis the use of TRH, epinephrine, and normal saline were compared. TRH treated rabbits responded slightly better than those treated with epinephrine (the study focused on cardiovascular and respiratory parameters.) (Annals of Emergency Medicine, 5/89) I started this project with the aim of identifying alternative treatments for anaphylaxis. I had mistakenly assumed that there are a host of viable and effective treatment regiments for anaphylactic shock. What I discovered was that as of today, the only universally accepted therapy for acute anaphylaxis is... epinephrine. Due to it's alpha and beta adrinergic effects epinephrine is miraculously suited for anaphylaxis. It almost seems to be a natural antidote, a wonder drug with singular abilities in the treatment of anaphylaxis. f:\12000 essays\health & humanities (196)\Tuberculosis 2.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ TB is a disease that can cause a serious illness and can damage a person's organs. Every year more than 25,000 people in the U.S. are diagnosed with TB disease. That's only a fraction of the amount of people who carry the Mycobacterium tuberculosis. Mycobacterium tuberculosis is a rod-shaped bacterium. TB is spread through the air by carriers of the germ. People who breathe the same air can become infected with the TB germ. People who do work around or with people with the TB disease should take medicine. TB infection means that the person has the TB germs but they are in an inactive state. When TB germs enter the body, the immune system builds a wall around them. While TB germs are inactive, they cannot cause any damage. These germs can stay alive for many years in these walls and eventually break out. At this time TB is active then it becomes TB disease. It can now affect the system's organs. A person can have TB disease shortly after being infected with TB germs if the person's immune system is weak. TB can attack any part of the system. The lungs are the most common area of attack. People with the TB disease have one or more of the following symptoms: a cough that hangs on, fevers, weight loss, night sweats, constant fatigue, and loss of appetite. A person with the TB disease in the late stages will cough up blood streaked sputum. People who have Active TB disease usually only have mild symptoms. There are three tests to diagnose TB disease. One is the Tuberculin Mantoux PPD skin test; two is a Chest X-ray which is given after the Skin test is positive; three Sputum Test reveals if TB germs are in thick liquid a person coughs up. The Tuberculin Mantoux PPD skin test is given by placing a substance called PPD Tuberculin under the top layer of the skin with a very small needle and syringe. The doctor will inject the needle into the skin which will only feel like a slight pen prick. A few days later the skin test reaction will be read by a trained health worker. If the skin around the prick is raised and it is bigger or the same size as a pencil eraser then the person is likely to have been infected with TB germs. This does not mean he or she has TB disease. You should always retest yourself even if the first test was negative for a few reasons. If your immune system has been weakened, then your immune system may not react to the skin test. The test also might have been taken too early after infection because the blood has not been infected. Inactive and Active TB can be treated by various ways. If you work or are around people with Active TB you should take medicine. Just because you are infected with TB germs doesn't mean you have TB disease. Having inactive TB will not hurt you now but you could develop TB disease later in life with out taking appropriate medicine. By taking medicine now you can wipe out the germs before they become active. People who have other illnesses that weaken their immune system should especially take medicine to prevent TB disease. The most common medicine to take is called Isoniazid or INH. Almost everybody can take INH. Some physicians will not give it to people over the age of thirty-five or to people with health problems that might be affected by INH. You must take INH for six months to completely wipe out TB germs. People who have other serious infections like HIV usually need to take for a longer period of time. INH is a very safe drug but can cause side-effects to some people. Changes you should look out for are yellowish skin, dark urine, vomiting, loss of appetite, nausea, changes in eyesight, unexplained fever, unexplained fatigue, and stomach cramps. There are other medicines as well for example rifampin. There is also an unproven vaccination called the BCG Vaccination. People that have had a BCG that have not had a skin test usually have to take the skin test when applying for work or school related environments. Bibliography Compton's Interactive Encyclopedia 96 Topic Search-Tuberculosis Internet Stanford University - Tuberculosis http://molepi.stanford.edu/ Tuberculosis Resources http://www.cpmc.comlumbia.edu/ World book 1997, Volume 19, Pages 389-391 The Merck Manual 1987, Fifteenth Edition, Pages 113-126 f:\12000 essays\health & humanities (196)\Tuberculosis.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Tuberculosis ---------- Tuberculosis (TB) is an infectious disease caused by a germ (bacterium) called Mycobacterium tuberculosis. This germ primarily affects the lungs and may infect anyone at any age. In the United States, the number of TB cases steadily decreased until 1986 when an increase was noted; TB has continued to rise since. Today, ten million individuals are infected in the U.S., as evidenced by positive skin tests, with approximately 26,000 new cases of active disease each year. The increase in TB cases is related to HIV/AIDS, homelessness, drug abuse and immigration of persons with active infections. How is TB Contracted? TB is a contagious or infectious disease that is spread from person-to- person. A person is usually infected by inhaling the germs which have been sprayed into the air by someone with the active disease who coughs. However, inhaling the germ does not usually mean you will develop active disease. A person's natural body defenses are usually able to control the infection so that it does not cause disease. In this case, the person would be infected, but not have active disease. Only about 10% of those infected will actually develop TB in their lifetimes. Active disease can occur in an infected person when the body's resistance is low or if there is a large or prolonged exposure to the germs that overcome the body's natural defenses. The body's response to active TB infection produces inflammation which can eventually damage the lungs. The amount of damage may be quite extensive, yet the symptoms may be minimal. The usual symptoms of disease due to TB are: •Fever •Night sweats •Cough •Loss of appetite •Weight Loss •Blood in the sputum (phlegm) •Loss of energy Diagnosing TB To diagnose TB, your clinician will gather five important pieces of information: •Symptoms •History of possible exposure and onset of symptoms •Tuberculin skin test or PPD •Chest X-ray •Sputum test Tuberculin Skin Test The tuberculin skin test (or PPD) is performed with an extract of killed tuberculosis germs that is injected into the skin. If a person has been infected with tuberculosis, a lump will form at the site of the injection--this is a positive test. This generally means that TB germs have infected the body. It does not usually mean the person has active disease. People with positive skin tests but without active disease cannot transmit the infection to others. Chest X-Ray If a person has been infected with TB, but active disease has not developed, the chest X-ray usually will be normal. Most people with a positive PPD have normal chest X-rays and continue to be healthy. For such persons, preventive drug therapy may be recommended. However, if the germ has attacked and caused inflammation in the lungs, an abnormal shadow is usually visible on the chest X-rays. For these persons, aggressive diagnostic studies (sputum tests) and treatment usually are appropriate. Sputum Test Samples of sputum coughed up from the lungs can be tested to see if TB germs are present. The sputum is examined under a microscope (a "sputum smear") to look for evidence of the presence of TB organisms. The organisms are then grown in the laboratory to identify them as TB germs and to determine what medications are effective in treating them. These studies are referred to as culture and susceptibility testing. State health department laboratories and reference laboratories can perform such testing. Treatment of TB Individuals with a positive tuberculin skin test may or may not receive preventive drug therapy depending on the exposure history, the timing of the skin test conversion (when the test changes from negative to positive) and other factors in the individual's medical history. When it is known that a person has recently been in close contact with an individual with active tuberculosis and has developed a positive tuberculin skin test, preventive treatment is advisable due to a relatively high risk of developing active disease. Isoniazid (INH) may be prescribed for six to nine months as preventive treatment and for twelve months in persons who are HIV positive. Since the advent of anti-tuberculosis drugs in the 1940s, the treatment of drug susceptible tuberculosis has become highly effective if administered and taken properly. Treatment no longer requires prolonged hospital stays. In many cases, a patient with a new case of TB can be treated at home. Others will enter the hospital to be placed on a medication program and to be isolated until the disease is controlled. When the person is no longer infectious, he or she can leave the hospital and continue on medication at home. Hospitalization in such cases may be a few weeks to several months depending on the severity of the disease and the effectiveness of the treatment program. In most cases, a treatment program for drug-susceptible TB involves taking two or four drugs for a period of time ranging from six to nine months. Medications may include isoniazid, rifampin, pyrazinamide, ethambutol or streptomycin. It is necessary to take multiple drugs and to take all of the doses prescribed, because all of the TB germs cannot be destroyed by one drug. It is important to realize that hospitalization for a TB patient, when necessary, represents only the beginning of treatment. Since active TB is slow to respond completely to therapy, medications prescribed by a clinician must be taken faithfully for a long period of time (at least 6 months, in some cases for a year or more). If the TB medications are not taken regularly, serious complications may develop: •the organisms may become resistant to one or more of the drugs, •there may be an increased risk of toxic reactions from the drugs and •there is a high risk of disease relapse or recurrence. Given the many effective medications available today, the chances are excellent that tuberculosis in an individual can be cured. It is important, however, for the patient to understand the disease and to cooperate fully in the therapy program. Drug-Resistant TB In a small percentage of cases, the initial treatment does not go as planned. It may be that the patient is not taking the medications regularly, the medication program is not sufficient for a particular infection or the medications are not absorbed properly. In these patients, there is a tendency for the germs to become resistant to some or all of the drugs. Sometimes a person has initial drug-resistant disease. In other words, the TB germs they contracted were from a person with drug-resistant TB. Drug-resistant TB is very difficult to treat and requires more and different medications for a longer period of treatment. Sometimes, surgery is needed to remove areas of destroyed lung that contain many millions of germs that are inaccessible to antibiotics. A person with drug-resistant TB should be treated by a specialist with considerable experience in managing the disease and this treatment should be initiated in a hospital setting. TB and National Jewish Since 1899, the National Jewish Center for Immunology and Respiratory Medicine in Denver has treated tuberculosis patients. The hospital was established to care for the thousands of persons who flocked to Colorado's high altitude and dry climate, seeking the elusive cure for their tuberculosis. In 1919, a research department was established at the hospital. When anti-TB drugs became available in the late 1940s, National Jewish was one of the first institutions to base its TB treatment program on the new chemotherapy, contributing refinements and developing combinations of drugs to overcome the problems of drug toxicity and resistance. Today, National Jewish is one of the world's leading centers for the diagnosis and treatment of tuberculosis. Research continues at the Center to define new approaches to treat difficult TB infections. Our world renowned doctors are backed by state-of-the-art laboratories that help them select the most effective drug combinations and dosages. For drug-resistant TB, the New York Times recently wrote that National Jewish provides "the most sophisticated and aggressive treatment the world has to offer." National Jewish offers a comprehensive evaluation for TB and drug-resistant TB. It is important to have a referral from the doctor along with previous medical records, chest X-rays and recent TB drug susceptibility testing before scheduling a TB evaluation at the Center. In most cases doctors refer a patient for our highly specialized in-patient program. To refer a patient for a TB evaluation, a doctor can call 303-398-1279. In addition, doctors and other health-care professionals can use this number to obtain consultations regarding current diagnosis and treatment information. Consultation is available for health-care professionals only. f:\12000 essays\health & humanities (196)\values.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ MATT HEALTH OCT. 21, 1996 ESSAY ON VALUES Three important values that I hold, are hard work, family, and friendship. These are values that I think will make life better and easier for a person. They make me feel secure and prepared for the future. Without these things I probably wouldn't care about anything at all. My values were all influenced by my parents. The only one that I had to figure out mostly by myself, was to work as hard as I could. Hard work is something that I had to do in order to prove to myself that I was smart enough. It probably controls most of my life. I need to do everything right and get perfect grades to be satisfied, and so I'm always working as hard as I can. It sounds like a bad thing, but the hard work almost always pays off. Family is a value that my father taught me. He told me that family is the most important thing in life. Your family will always be there when you need them, and will love you no matter what you do. This is a great thing, because it gives me security and comfort. I know that the decisions that I make in life will be guided by people that care about the outcome, and if things don't work out they'll be there to do whatever they can to help me. You never have to put on a front with your relatives, they will almost always accept you for who you are. Another value that was influenced by my parents as well as television, is friendship. Even though your family is always there for you, friends are still very important to have. Having friends will usually raise a person's self-esteem. By having friends you know that you are a good person, and that people like you. Friends can also help you cope with problems that can't be discussed with you parents. If I am having a problem with any part of life, I know I could discuss it with a friend and get it resolved. Besides the obvious pros of friendship, it also prepares you for jobs and life in general. Friendship shows you how to get along and communicate with other people. f:\12000 essays\health & humanities (196)\Vinegar.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Chris Nacey Writing 101 Final draft 2-19-1997 Vinegar When I was a child, I spent a lot of time in the kitchen with my mother. She liked to cook and so did I. Because of this, I learned my way around the kitchen. I knew the place for everything, and I knew the uses of most everything. There was only one paradox, in my knowledge of the kitchen: vinegar. My mother had one bottle of vinegar for as long as I can remember. She never used it in cooking, or taught me how to for that matter. Our bottle of White Wine Vinegar sat in our cupboard: on the bottom shelf, enigmatically, untouched, detached. I knew that my mother wouldn't have it without reason. It was in the kitchen, so I concluded that it must be some sort of, rarely used, cooking staple. I would never have guessed then that vinegar had so many uses. Just the other day, I was in the mall visiting a friend that works at Frankincense and Myrrh. While there, I happened upon some bottles that caught my eye. They were attractive looking ornamental bottles. Each one was filled with mysterious, colored liquids: the colors varied from red to brown to yellow. In the liquids were berries', sprigs of herbs, and things of the such. I thought they looked interesting, so I picked up a bottle that I recognized as having sage in it. I took a look at the label. On the label were listed the ingredients: sage, rosemary, and southernwood leaves. When I read the front of the bottle, I was surprised to find that I was looking at an herbal vinegar hair rinse. Before this I never knew that such a thing existed. After my experience at the mall, I became aware that vinegar didn't just belong in the kitchen. This intrigued me. I decided to find out more about vinegar and its uses. Nobody knows the exact origins of vinegar, but there are many stories and beliefs surrounding this strange liquid.(Oster 3) The Roman Army was recorded to have mixed vinegar with water to make a sort of Gatorade for the soldiers. In the eighteenth and nineteenth century United States, similar drinks known as "shrubs" or "switchels" were made by field laborers. To make these drinks, they mixed either fruit juices or water, with sometimes salt, and fruit-flavored vinegars.(Oster 4) The earliest recorded use of vinegar, however, was in Babylonia around 5,000 B.C. There, it was typically made from dates, and commonplace as a medicine.(Oster 3) Throughout history, vinegar has been used medicinally. Via modern science we know vinegar to have antibacterial and antiseptic properties.(Oster 5) But before the convenience of laboratory analysis, Hippocrates (commonly called the father of medicine) recommended vinegar to his patients. One such recommendation was a vinegar, honey, and pepper douche for "feminine disorders."(Oster 5) Folklore has it that during a plague epidemic in Marseilles, four robbers drenched themselves with what is now known as "Four Thieves Vinegar." In doing so, legend say that they were able to pilfer the diseased and deceased without getting infected themselves.(Geddes) In the Civil War, vinegar was issued to counter scurvy. More recently, in World War I, vinegar was commonly accepted as treatment for wounds.(Oster 5) Other more modern medicinal uses for vinegar also exist. A mixture of apple cider vinegar and water, if used properly, can help reduce acne problems.(Geddes) A similar solution has been known to help with indigestion if taken regularly.(Oster 42) Cold apple cider vinegar can also help relieve the pain of sunburns.(Geddes) Vinegar also has many uses around the house. Because vinegar is acidic by nature, it is very useful for a spectrum of cleaning uses and other tasks. Vinegar is relatively inexpensive and, by comparison to the mass-produced toxic chemical cleaners, potent. For most home uses, one would usually dilute the vinegar in water. A one gallon bottle of apple cider vinegar could replace a whole box full of harmful chemicals found littering the common home. Vinegar can both remove stains from wooden furniture and act as polish.(Oster 33) When your drain gets clogged, you don't need to buy the toxic liquid plumber. You can pour a handful of baking soda down the drain, add a half a cup of vinegar, and then cover the opening for five to ten minutes. Doing this will unclog your drain.(Geddes) I have found several innovative uses for vinegar. The uses listed here are only a few of the many that exist. After learning about them, I have found ways to save money and be enviromentally safe at the same time. I still don't know exactly why my mother kept vinegar in her kitchen; maybe she was just trying to save the world from harmful pollutants. I do, however, see numerous reasons for me to keep it in mine. Works Cited Geddes, Lynn. Personal Interview. Washington. 14 February, 1997. Oster, Maggie. Herbal Vinegar. Vermont: Storey, 1994. f:\12000 essays\health & humanities (196)\Vitamins.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Vitamins (2) In the early 20th century the discovery of vitamins began. Today there is a chance that there are some vitamins that are still undiscovered. The definition of vitamin is: one of several substances necessary for animal nutrition, and occurring in minute quantities in natural foods; numerous types have been distinguished, and designated by the letters of the alphabet. Each and every living animal needs vitamins to grow and be healthy. Since the human body can t produce vitamins naturally or normally produce the amounts needed, food provides the body with them. There are different vitamins found in different foods. These vitamins give vital nutrients to an animal. In 1906, the British biochemist Sir. Frederick Hopkins demonstrated that foods contain accessory factors in addition to proteins, carbohydrates, fats, minerals and water. Then, in 1912, thee chemist Casimir Funk identified that the (3) antiberiberi substance in unpolished rice was an amine (a type of Nitrogen-containing compound), so Funk proposed that it be named vitamine, from vital amine. It was later discovered that different vitamins have different chemical properties. This discovery caused vitamine to be turned into vitamin. In 1912 Hopkins and Funk made a hypothesis. The hypothesis stated the absence of some vitamins could cause diseases such as beriberi and scurvy. Later a letter was assigned to each vitamin. The letters which were assigned to vitamins in the early years of vitamin research categorize them according to their functions. As research progressed, the vitamins were given scientific names. Foods that contain vitamins are very essential for good health and growth. Milk can be important because it is a source of vitamin D. Vitamin D is important because it is essential for bone growth. (4) Butter can be important because it is a source of Vitamin A. The pigments that are converted into Vitamin A, are found in most fruits and vegetables. Vitamin A is important because it can prevent diseases. Cereal and seeds can de important because of its source of Vitamin B. Vitamin B is important because of their source of Vitamin B. Vitamin B is important because it can prevent beriberi. Citrus Fruits can be important because of their source of vitamin C. Vitamin C is important for strength and metabolism. Plants can be important because of the plant oil which is a source of Vitamin E. Vitamin e is important because it is a source of oxidation in body tissues. (5) These examples prove that the distribution of vitamins in natural sources is uneven. Take vitamin D for example. It is produced only by animals, where as some other vitamins may only be found in plants. Vitamins can be synthetically produced or found naturally, but there is no proof that either natural or synthetic vitamins are superior to one another. There are two categories of vitamins needed in the human body. The first are water-soluble vitamins, like B and C. The second category is fat-soluble vitamins, such as vitamins A, D, E, and K. Water-soluble vitamins are absorbed by the intestine. Once the intestine absorbs them, the circulatory system carries them to certain tissues. Fat-soluble vitamins are also absorbed by the intestine, and the lymph system carries the vitamins to the various parts of the body. These vitamins are responsible for maintaining the structure of the cell membranes. (6) Don t think that you can have as many vitamins as you want. If too many vitamins are taken into the body, the vitamin levels in the body become toxic. Since the body can t produce the essential amounts of vitamins, there must be a certain requirement of intake of vitamins and vitamin supplements. These requirements are known as the recommended daily allowance, or RDA. If these requirements aren t met, you can become a very unhealthy person. The food and Nutrition Board of the National Academy of Science/National Research Council in the United States establishes these RDA s. For different worldwide population groups two agencies of the United Nation, the Food and Agriculture Organization and the World Health Organization have developed RDA s. It is wise to follow the RDA. Without correct interpretation of the RDA, a person could take too many or take too few vitamins. This proves that vitamins can be beneficial of harmful depending on the usage. f:\12000 essays\health & humanities (196)\Why Do Parents Abduct .TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ "Why Do Parents Abduct?" According to the U.S. Department of Justice, over 354,000 children are kidnapped by a parent each year in divorce custody disputes. Some of the children are recovered or returned quickly while others may be on the run for years. Unfortunately many of these children are never found. Generally, people are concerned with the traumatic effects of these events on the child involved. However, both the searching parent and the abductor have many pending issues with which to deal. Some people believe that children "kidnapped" by their own parents are the lucky ones. In fact, because revenge is often the driving force for these abductions, the child may become subject to physical, sexual and mental abuse. While "When Families Are Torn Apart," is written by Mary Morrissey, the majority of the article is quoted from Geoffrey Greif and Rebecca Hegar. In the article, Greif and Hegar explain how they attempted to fill in the gap of information about the trauma of long-term abduction. Their findings appear in the book When Parents Kidnap. Each parent, child, and abductor may deal with the kidnapping differently. For some it is very frightful and requires years of psychological evaluation to overcome. According to Greif and Hegar, abducted children develop extremely close bonds with their abductors. Often the abductors lie to the children about the other parent. They may say that the other parent does not want the child or is dead. The longer the child is away the harder it is for everyone involved. At these times, professional help is strongly suggested. Issues for Parent · their own feelings about the abduction · helping them to be able to care for the child · helping them to bring the whole family together · helping them to help readjust the other children · helping them to cope with any odd behavior that may be exhibited by the abducted child · developmental changes of the child Issues for Children · trust · sexual abuse · anti-social behavior · why the child thinks the abduction occurs · dealing with the length of the abduction and the time that they missed with the rest of their family · experiences during the abduction · they child may have been brainwashed by the abducting parent · whether or not she wants to return to the abductor · being scared about the chance of being abducted again · + many others Issues for Abductor · anger against court · anger at the other parent · anger or confusion about the child's new outlook on them · sense of loss because they are not seeing the child · inability to move on with their life · concern about the child's welfare · guilt if they think the child has suffered · realizing the harm they have done to the child · dealing with the behaviors that led to the abduction The article, "Parents Who 'Kidnap,'" recaps specific cases of parents attempting to recover abducted children. In the first case, Sandy Kearns is searching for her son Joshua who had been abducted by his father. Sandy's husband had run off with his son in the past. She was told by police that it was a civil matter and received no assistance. The next afternoon she was told by police officers that her husband had shot her son and then himself. The next case is about Cynthia and Julian Smith. Cynthia's son Julian was stolen away when he was two. Five years later, abused both sexually and emotionally, Julian was rescued by his mother. Julian has receive endless hours of psychological help that will have to be continued throughout his life. He is finally adapting to school and his new life and is making friends. The subsequent example involves Jeff and Autumn Young. This story depicts how some children's appearance is changed and they are restricted in all ways from having contact with the outside world. Jeff's ex-wife stole away with their daughter during his custody case in court. Jeff spent his savings on lawyers and detectives who could not find his daughter. Shortly after Jeff and his new wife had a baby, his daughter was found in Florida. Extremely underweight, dirty and pale, Autumn went home with her father. After all of her medical check-ups and some sessions of unconditional love, Autumn is happy to be home with "two people who know what they're doing." The next case concerns Joe, Paula, and Jo-Jo Palancia. Federal law says that custody decisions can not be overridden by courts in different states. This is a fact unfamiliar to many judges. Joe Palancia's wife had abducted their two children after she had consented to allowing them to live with their father. Six years later the children had been found and Joe was back in court. After $800 worth of phone call inquiries and $3,000 worth of legal fees, Joe's wife again agreed to let Joe take the children. His wife eventually spent 4 months in jail. Finally a happy family once again, Joe, Paula, and Jo-Jo do the things regular families do and their lives have calmed down somewhat. The last incident involves Steve and Stephen Fenton. Steve agreed to allowed his wife to take Stephen, then six, to Mexico for three weeks. Steve's wife never returned with Stephen. Abductions outside the United States do not fall under American law, but Steve was told that the recovery rate from Mexico was 90%. Seventeen months of attempted recovery had failed and Steve realized he needed to try something else. He hired a man for $51,000 to re-abduct his child. When a kicking and screaming Stephen was finally retrieved, Steve had to slowly rekindle memories to reassure the child that he was his father. Months later, Steven watches his child play soccer and despite being looked down upon by his caseworker, is content with the method he used to rescue his precious son. Whereas Geoffrey Greif sees abduction as the 'extreme end of divorce,' Deborah Linnell, a Project ALERT volunteer, calls it 'an extreme form of domestic violence.' I feel that abductions are the combination of the two. Certainly stealing away with your child without telling the other parent can be considered domestic violence. You can hurt someone just as much emotionally as if you had stabbed them with a knife or cut off their arm. Just as applicable is that this is an extreme, and excessive end to a divorce dispute. What I found interesting about the reunification process in these cases is that they are often depicted in both movies and books as a joyful reunion. When if fact, the assimilation of an abducted child to the family that they have not seen in years is not always so smooth. I was appalled by the lack of assistance from the police and the ignorance of the courts. The idea that a parent would kill their own child and take their own life as well, solely to prevent their ex-spouse from being with the child is incomprehensible. Both of the articles were extremely informative. The techniques used to write the articles were equally effective, giving a different perspective on the stories. The possibility of recovering after an event as traumatic as abduction through psychological counseling is a welcomed and exciting idea. The course on "Introduction to Psychology" has opened my eyes to the extent that psychology can go to help make a difference in the lives of people everywhere. f:\12000 essays\health & humanities (196)\why sex ed should be taught in schools.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Why sex education should be taught in schools Most America teenagers are sexually active and think nothing could ever happen to them. But, many of them are misinformed about the risks that are involved in sex. Teens also don¹t always know the best ways to protect themselves and their partners from becoming pregnant or getting STD¹s. Alan Harris said, the more educated someone is the more likely they are to make responsible and informed choice for their behaviors. Sex education given by teachers at school is the most relabel way to give kids the right information about sex. In schools sex education information is give by professional and has be proven by many reports all over the country and world. The first formal attempts at sex education was introduced by a Dr. Arnold a schoolmaster at a public school. Dr. Arnold used the Bible to make the schoolboys fell guilt and scared of sex and masturbation. The nineteenth-century scare tactics books of Dr. Arnold were nothing like the sex book used by the sex educations teachers of today(Greaves. pg.171). Schools that have sex education taught by a sex education professions and that use reports and survey from all over the country and world are the most convening sources of information. They have had the most influence on my decisions about sex as well as many other teens. Parents and other teens can give out wrong information about sex that can give a false scene of security, which can lead to a unwanted pregnancy or STD. Sex education must be taught in schools so, student get the right information. Most parents fell that the best place for sex education is in the home. The parents can teach their children family and religious values. Teacher Mary L. Tatum says, Schools do a better job influence children and have more time to try to influence children better that anyone except, perhaps, the parents. It is important that parents give sex information but, school need to reinforce what the parents teach to make sure that the information is correct. Most people who are against teaching sex education in schools have the opinion that, ³Sex education encourage students to become sexually active at younger ages.² But, ³The World Health Organization has reviewed 35 scientifically controlled studies in the U.S. and abroad, and found that no program increased the invitation of sexual intercourse over the control group.² Not all parents know how to talk to their children and if they do the children do not always understand or listen to what the parents have to say. Some mothers wait to ask embarrassed daughter just before their wedding, ³You do know what to do, don¹t you?² or, ³Do you want to ask me any questions?²(Kelly .101) Parents of the bride usually assume that the husband will know what to do about sex. According to APPCNC (Adolescent Pregnancy Prevention Coalition of North Carolina) research, parents who talk to their children about sex tend to encourages they children to delay first time sexual intercourse. The children will also become sexually active at a older age and are more likely to prevent unwanted pregnancies and STD¹s. But, passed attitudes of parents is, once a child is taught about sex they fully understand all that is needed to be understood and there is never a need to talked about sex again.(Berne. pg.2) Some children do what ever the parents tell the not to do. In this case it would be bad to have the parents talk to the child and will get their sex education for another source, their peers. Peers exchange information in locker rooms, play grounds, and parties. Dorothy W. Baruch found that, Childish Imagining usually changes sexual ideas a lot more that getting facts. This is how many teens get most of their information about sex. The most important thing when teaching sex education is have accurate information that is taught to them so, they can make their own decision with correct information when the have to make that choice. The best to get this information is at school for a teacher or other trained professional. The North Carolina Coalition on Adolescent Pregnancy found that, ninety percent of the people surveyed agree that, sex education should be taught in the public schools. Even parents agree, as show in Douglas Kirby studies, about three fourths of U.S. adult population supports making information and contraceptive available through school-based health centers. School-based Programs to Reduce Sexual Risk Behavior: Review of Effectiveness, states that, ³If effective programs are implemented in our nation¹s schools, they can have and important impact upon reducing sexual risk-taking behavior...² It can also, ³provide and effective component in a large overall strategy to reduce unintended pregnancy, STD and HIV² One out of ten America teenage girl under the age of 20 get pregnant each year (Berne .18). That¹s over one million teenage girls in our country alone. More that half of those pregnancies unfortunately end in abortions or miscarriages. If the teen mother is not married and choose to have the baby anyway, four percent of the babies are put up for adoption (Berne .155). Half of the pregnant teens will lose their babies from abortion or miscarriage and those that don¹t will have to suffer with the effect that pregnancies have on teen mothers. When pregnant teenagers decided to have their babies and keep them, there are many consequences that effect them before, during, and after labor. Some of the consequences are: 8 out of 10 teenagers are likely to drop out of school, 72 percent will divorce by 18, the legal age of marriage, the risk of committing suicide is 10 times greater, they are 100 times more likely to abuse their child, and the risk of birth defects and complications in a teen mother are two to three times higher than in an adult mother(Berne .9). Teen sex and pregnancies is out of control in America. These teen mothers are not ready for sex or pregnancies. The median age of first sexual intercourse for girls is just above sixteen years old (16.2), or 11th grade and the median age for boys is around fifteen and a half years old (15.7) or 10th grade. Kids who live in poor and or broken homes do poorly at school, have no interest in college, and whose parents have low education; are one to three years younger the first time they engaged in sexual intercourse(Berne .4). Harriet Pilpel and Laurie Rockett have found in a study of parents that, eighty percent of the parents believed the sex education should be taught in schools. The SIECUS report of November 1979 found that, only one to three percent of parents did not give their children permission to attend the schools sex education class. Sex education is best when taught in schools. Because, schools have professional teaching the information and get their information from surveys and reports. Teens do not always get along with their parents and will not take the advise evening if it is right information. And the teens peers usually spread false information around to each other which can be harmful or even deadly for teens. If the schools are allow to teach to students hopefully it will help the teens to make the right decisions to prevent unwanted pregnancies of STD¹s. Works Cited Adolescent Pregnancy Prevention Coalition of North Carolina. The Advocate, 1995. pg.10. Baruch, Dorothy Walter. New Ways in Sex Education: New York, McGraw-Hill, 1959. pg.41. Berne, Linda A. and Barbara K. Huberman. 17 Arguments Against Comprehensive Sexuality Education And The Answers From Scientific Literature. class handout. 1994.pgs.1-9, 155. --- Dealing with the Reality of Teen Sexual Behavior, class handout, 1994. pg.4. Greaves, Norman. J. Sex education in College and Department of Education; Health Education Journal, . 1965. pg.171-177. Harris, Alan. Sex Education, Rationale and Reaction , What does ŒSex Education¹ Mean? Cambridge University Press, Ed. Rogers, 1974. pg.19. Huberman, Barbara and Douglas, Karin, The North Carolina Coalition on Adolescent Pregnancy: March 1993. pg.5. Kelly, Gary F. Sex Education in the Eighties: Parents as Sex Educators, New York, Plenum Press, 1981. pg.101. Kirby, Douglas. School-Based Program To Reduce Sexual Risk-Taking Behaviors: Sexuality and HIV/AIDS Education, Health Clinics And Condom Availability Programs.class handout. 1994. Pilpel, Harriet and Rockett, Laurie, Sex Education in the Eighties: Sex Education and the Law, New York, Plenum Press, 1981. pg.19. Tatum, Mary Lee. Sex Education in the Eighties: Education in the Public School, New York, Plenum Press, 1981. pg.138 Roberts, E.J., and Holt, S.A. Parents-child communication about sexuality. SIECUS Report, 1980, 8(4), 1-2,10. World Health Organization , Technical Report, pg.572. 1994. f:\12000 essays\health & humanities (196)\Work Stress.TXT +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ 1.0 Introduction Throughout the eighties and into the nineties, work stress have continued to rise dramatically in organizations across North America. The eighties saw employees stressing out from working in a rapidly growing economy. During the nineties, beginning from the recession of 1992 till present day, employees are stressed by their own job insecurities in the face of massive downsizing and restructuring of organizations in order to be competitive on the global stage. Work stress is a very extensive topic ranging from research on the sources of stress, the effects of stress, to ways on managing and reducing stress. This report will focus first on the evidence for the harmful effects of stress at work, both mentally and physically. The last section will briefly explain why management should be concerned with rising employee stress and will describe some actions management can take to alleviate work stress. 2.0 Harmful Effects of Stress Most research studies indicate a high correlation between stress and illness. According to authorities in the United States and Great Britain, as much as 70% of patients that are treated by general practitioners are suffering from symptoms originating from stress . Everyone experiences stress, however, each person responds to stress very differently. Their response is dependent on how each person reacts to stress emotionally, mentally, and physically. There are, however, common effects of stress for most people on the physical and mental body. 2.1 Physical Effects The researcher Blyth in 1973 identified a list of diseases which have a fairly high causal relationships with stress. His evidence was obtained through interviews with medical experts, review of reports by the World Health Organization and consultations with the J.R. Geigy Pharmaceutical Company. The following is a list of some of the illnesses Blyth had identified : 1. Hypertension2. Coronary thrombosis3. Hay fever and other allergies4. Migraine headaches5. Intense itching6. Asthma7. Peptic ulcers8. Constipation 9. Rheumatoid arthritis10. Colitis11. Menstrual difficulties12. Nervous dyspepsia 13. Overactive thyroid gland14. Skin disorders15. Diabetes mellitus16. Tuberculosis Research conducted by Woolfolk and Richardson in 1978 further confirmed Blyth's list that hypertension, coronary disease, infections, and ulcers are highly related to the amount of prolonged stress an employee is subjected to. Evidence for a causal relationship between hypertension and stress was seen in a study of air traffic controllers. The work stress is enormous for this occupation due to the high responsibility for the safety of others that people is this field must bear. This study noted that air traffic controllers experiences a hypertension rate approximately 5 times greater than other comparable occupational groups . Only in recent studies was stress linked to coronary disease. As the majority of heart attacks are caused by fatty substances adhering to the artery walls (arteriosclerosis), stress is a causal factor in that, at high levels, the amounts of the two fatty substances, cholesterol and triglycerides, in the blood steam are elevated. This is evidenced in one study of tax accountants. As the deadline for the annual tax filing drew nearer, cholesterol levels rose without decreasing until 2 months later. The situation here shows that cholesterol in the blood rises gradually with constant exposure to stress. There is also strong evidence for the causal relationship between stress and infectious disease. Woolfolk was able to show that employees that are very fatigue (a symptom of stress) were more susceptible to infections. In his study conducted upon 24 woman during the flu season, every woman was administered a certain amount of flu virus into their blood stream. Woman in the group who were fatigued were administered a smaller dose than those who were not. Woolfolk found that the women who had just gone through very stressful experiences were more susceptible to the infection despite a very small dosage of the flu virus. The other women who were not tired did not get infected even though they had considerably high dosages of flu virus in them . Lastly, evidence that ulcers are associated with high stress levels have been conclusively proven by Woolfolk. Ulcers occur when digestive juices burn a hole in the stomach lining. A person under stress or anxiety would stimulate the rapid secretion of digestive juices into the stomach. Thus, when a person is subjected to constant tension and frustration, he / she has a high likelihood that an ulcer would occur. Evidence for this was provided by the study performed by Dr. Steward Wolf. He was able to monitor activities of a patient stomach, and where the patient responded to an emotional situation, he observed the excessive secretion of stomach acids. Woolfolk and Richardson further the studies by showing increased levels of stomach acids during high exposure to stress. 2.1 Psychological Effects Most organizations have recognize that stress can have an adverse effect on the efficiency of their employees. In 1978, the International Association of Chiefs of Police (IACP) cited their study report that there are essentially three psychological reactions to consistently high stress levels: repression of emotion, displacement of anger, and isolation. Repression of emotions occur often in human service professionals such as policemen or accountants. Their roles demand that they suppress their emotions when interacting with clients. Thus, when the stress levels begin to rise as they deal with more and more clients, they would put up an even greater resistance to their own emotions . Over time, the professional may not be able to relax that emotional resistance. All their emotions would be masked and retained within themselves, resulting ultimately in mental and emotional disorders. In stressful times, employees are often displeased or angry with something. However, there are usually limited channels in which employees can express their views. Since opinions, views, and feelings cannot always be expressed to anyone to change the current situation, there would be an accumulation of anger and frustration within the individual. Up to a certain point, the anger would be released, usually at the wrong person or time, such as colleagues, clients, or family members. This symptom has a tremendous impact on society because there is a potential that it may hurt others people. Take for example the US postal shootings over last few years. All of them were a result of accumulated anger and frustration of US postal workers where they eventually released all that pent-up anger at one time towards other colleagues. Moreover, many cases of spousal abuse, child abuse, alcohol abuse, dysfunctional families are a result of overstressed employees unable to diffuse or cope with the anger and frustration building up within them. The 1978 IACP's report stated that isolation is a common side-effect of working under tremendous stress. For many service practitioners, they are not always readily welcomed by the clients that they serve. A prime example would be policemen who are shunned often by the public. Over time, a feeling of isolation and rejection would envelop the person. The natural thing to do would be to withdraw from others who do not understand their plight, resulting in profound human loneliness . The symptoms mentioned above are usually long-term effects. There are many other short term, psychological effects of stress that can be readily seen or felt. The following is by no means a definitive list of mental effects as it only illustrates some of the symptoms that could readily identified in a person under constant stress : 1. Constant feeling of uneasiness2. Irritability towards others3. General sense of boredom4. Recurring feelings of hopelessness in life5. Anxiety regarding money6. Irrational fear of disease7. Fear of death8. Feelings of suppressed anger9. Withdrawn and isolated 10. Feelings of rejection by others (low self-esteem)11. Feelings of despair at failing as a parent12. Feelings of dread toward an approaching weekend13. Reluctance to vacation14. Sense that problems cannot be discussed with others15. Short attention span16. Claustrophobic 3.0 Management's Role in Reducing Work Stress Employee stress can have an enormous impact to an organization in terms of cost. As many studies have shown, there is a high correlation between stress and job performance. At moderate levels, stress is beneficial in that it can cause individuals to perform their jobs better and attain higher job performance. However, at high levels, stress can decrease productivity instead. This is the case often seen in employees at many organizations . Furthermore, aside from costs associated with lost productivity, there are costs with respect to stress-related absenteeism and organizational medical expenses. Specifically, these include costs of lost company time, increases in work-related accidents disrupting production, increases in health care costs and health insurance premiums, and most importantly, decreases in productivity . There are numerous methods that organizations could adopt to reduce undue stress in their employees. However, measures taken to counter this problem are usually tailored specifically for the particular organization. Therefore, this report has chosen two separate actions which are fundamental to most organizations that management can take. 3.1 Reduction of Employee Stress as an Organizational Policy The first step any organization should take to help its employees reduce and cope with stress is to incorporate into the company policies a positive and specific intent on reducing undue stress. This would indicate that top management is committed to such a stress reduction program. Furthermore, the amendment to the policies should also include a recognition that this initiative will benefit the achievement of other organizational goals by enhancing the productivity of employees through lowered stress levels . After the inclusion of the broad mission goal of reducing employee stress, management should draft out plans which specifically lays out the provisions to accomplish that goal. As earlier mentioned, there are many approaches to stress reduction, thus the provisions should detail only the methods specific to the organization. For example, they could specify that employees undergo periodic physical and psychological examinations and personnel surveys to ascertain current stress levels. Another alternative would be to provide personal counseling to employees to identify undue stress levels and then to advise any corrective measures for the individual. In any case, the most important beginning step is a total reexamination and revision of company policies, plans, and procedures to enhance employees' own methods of coping with stress, and simultaneously, promote an organizational climate which actively assists employees to minimize their stress. 3.2 Fundamental Techniques to Employee Stress Reduction One method management can employ to alleviate employee stress is to make them fitter to deal with the everyday pressures of work . There are three basic management techniques that would accomplish this goal. Managers should be clear about their expectations of employees and clearly convey these expectations to each person. Secondly, management should devise a performance-evaluation-feedback system such that each employee would be aware of his / her performance level based on the feedback received. Lastly, employees should be fully capable of performing their job tasks. Stress arises when employees do not possess the necessary skills to carry on with the work assigned to them. Therefore, job training programs are essential to reducing anxiety and stress associated when employees feel that they do not possess sufficient skills or knowledge to perform the job that they were hired for. 3.2.1 Communicating Management's Expectations In an organization, it would appear that all employees have a clear understanding of their roles they were hired for and the duties expected of them. This assertion is often valid for employees working at the front line, such as workers on an assembly line. Strict procedural guidelines dictates the tasks and procedures each worker would assume. However, at higher levels in the organizational hierarchy, an employee's duties and responsibilities may not be as apparent. A middle manager or team leader's role could entail many different responsibilities and duties such as managing, coordinating, leading, planning, etc. Despite a detailed job description when the individual was hired, there often exists a cloud of ambiguity as to what the position exactly encompasses given the wide-ranging scope of the position . Work stress arises as a result of this because employees would be distressed over uncertainty of the sufficiency of their tasks in relevance to their position and role. Furthermore, employees may not be clear as to the amount of work expected of him or her. When employees do not know how much effort they should commit to their jobs in order to satisfy their superior's expectations, a certain level of employee work stress would arise in that the individual would be constantly worried about the adequacy of his / her level of effort. In essence, employees need to know exactly the tasks expected of them and the level of effort to put into those tasks. The issue here is essentially a communications problem between management and employees. Management should communicate its expectations to employees whether as a group or individually. Since increased communications is the primary solution in this case, management should also promote a working environment where employees are encouraged to voice their concerns, questions, etc. to their respective superiors. Managers, themselves, should adapt a managing style that is sensitive and responsive to employee stress. Communication of management expectations can be achieved by analyzing each role in the organization to clarify priorities and resolve conflict between roles. This approach would first, clarify any ambiguity an employee may have about his / her position. Secondly, it effectively eliminates the stress from not knowing what or how much to do. Informing employees of their role expectations is only the beginning to reducing stress levels . Employee also require feedback from their performance measures. 3.2.2 Providing Feedback to Employees Once role expectations are known, employees require feedback on their performance to determine whether those expectations are met. In the absence of feedback, employees would be worrying if their current levels of effort are satisfying the expectations of them. A state of ambiguity would arise again, resulting in increased stress levels. A systematic approach in providing periodical performance feedback to all employees in the organization is required. One common approach adopted by many companies are staff and staff-development schemes. They entail a periodical one-on-one interview between managers and each of his / her subordinates. During the interview, the manager would inform the employee of his / her performance relative to previously set standards (ie. expectations). The employee would be encouraged to provide his / her concerns regarding the performance evaluation. Any problems and / or requests for assistance would be communicated to the manager at this point. To conclude the interview, the employee would set attainable future goals to improve or maintain the current performance level. Royal Bank is a strong advocate of staff-development schemes. Employees meet with their managers once every four months to discuss the employees' performance to-date. The interview process is characterized by the supportive and encouraging roles every manager adopts towards their subordinates. Unlike many other appraisal interviews, managers do not only focus and highlight employee weaknesses. When certain deficiencies in performance are discussed, managers recognize that negative feedback is uncomfortable to both parties and can also be counter-productive. Thus, they usually identify areas for improvement to employees in a very supportive approach. The objective is to rectify the deficiency by motivating the employee to change, rather than imposing additional stress on him / her by merely pointing the weakness(s) out. 3.1.3 Job Training Programs Job training programs provide employees with a broader knowledge and skills enabling them to better handle the expectations from their roles. Employee stress is often caused by the lack of skills or knowledge to meet designated objectives and goals. These programs usually take on two forms - knowledge-based development and skills-based development. Knowledge-based development programs usually involve a conference or seminar where the aim is to broaden the attendees' knowledge of a certain topic such as infomatics seminar briefing employees on the latest networking technologies. The knowledge gained from such programs may or may not be utilized in the everyday job routines of employees. Alternatively, skill-based development programs focus on training employees to become more proficient in the use of certain behaviours such as assertiveness training. While job training programs can reduce work stress, there are essentially three conditions to its success . First, the job training must be required by the employee. No benefit would be derived if an employee is trained for something that is not relevant to the work he / she performs everyday. Secondly, management must discourage any perception by employees that training programs are a form of reward or punishment, or else the entire purpose of the training initiative would be lost. Finally, preparation is required to benefit fully from the program. 4.0 Conclusion Work stress places a very high toll on both employees and employers. An employee subjected to high levels of stress could experience both physical and mental side-effects. Physical side effects such as hypertension, coronary disease, infections, ulcers could greatly decrease the lifespan of the person. The psychological effects such as repressed emotions, anger, and isolation have a direct negative impact on organizational productivity. Thus, organizations have a great responsibility in reducing the stress of their employees, and in general be concerned about their well-being. There are numerous methods to counter the stress problem. The report has cited only the basics which are applicable to most organizations. The first step for management is to set out the intention to reduce employee stress in as an organizational goal. Provisions detailing the organization's planned approach should be drafted. Informing employees of management's expectations is one method to reduce a large portion of the anxiety employees may have about their jobs. Secondly, management must provide subordinates feedback on their performance. Management should also provide job training for all employees to enable them to better perform their jobs and reduce the stress associated with the feeling of inadequacy to perform one's duties. Bibliography Alluisi, E. A., Fleishman, E. A. (1981). Stress and performance effectiveness. Hillsdale, N.J.: L. Erlbaum Associates. Arroba, T., James, K. (1987). Pressure at work: a survival guide. London; Montreal: McGraw-Hill. Greenberg, S. F., Valletutti, P. J. (1980). Stress and the helping professions. Baltimore: P. H. Brookes. Greenwood, J. W. (1979). Managing executive stress: a systems approach. New York; Chichester: Wiley. Kompier, M. (1994). Stress at work: Does it concern you?. Shankill, Ireland: European Foundation for the Improvement of Living & Working Conditions. Robbins, S. (1996). Organizational behaviour: concepts. controversies, applications. Englewood Cliffs, New Jersey: Prentice Hall Inc. Smither, R. D. (1988). The psychology of work and human performance. New York: Harper & Row.