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By: P. Renwik, M.A., M.D., M.P.H.

Clinical Director, Western Michigan University Homer Stryker M.D. School of Medicine

American women report that arthritis limits their ability to perform basic daily activities symptoms 0f high blood pressure purchase 2.5mg oxytrol mastercard, with rates of disability higher among certain groups of Native American women relative to European American women (Del Puente treatment 1st degree av block buy oxytrol 5mg on-line, Knowler, & Bennett, 1989). The etiology of rheumatoid arthritis remains unknown, although there may be a genetic predisposition to develop the disease. Treatment consists of reducing swelling, relieving pain, and reducing in"ammation (Arthritis Foundation, 2001; see chapter by Burke, Zautra, Davis, and Schultz in this volume for additional information). The fact that rheumatoid arthritis has its onset in middle age raises questions as to how the disease affects such things as pregnancy and breastfeeding. Subsequently, research is beginning to explore the relationship between rheumatoid arthritis and fertility (for a review, see Dugowson, 2000). Further research should explore the etiology and psychosocial factors of the disease. Finally, there is a need for health psychologists to facilitate the development of pain management strategies. Mental Health Issues 519 Fibromyalgia Fibromyalgia is characterized by a widespread pain syndrome and decreased pain threshold. Women represent 80% to 90% of patients with this disease (Belilos & Carsons, 1998), and approximately 2% of American women have the disease (Hawley & Wolfe, 2000). Symptoms include diffuse aches and pains, sleep disturbance, fatigue, headaches, irritable bowel syndrome, and psychological distress. Patients with this disorder often have dif"culty pinpointing the location of their pain. Diagnosis can be dif"cult since no single test is available to determine the presence of the disease. Therefore, diagnosis often is made after testing for other disorders reveals negative "ndings, or after patients are misdiagnosed because symptoms are similar to another disorder such as chronic fatigue syndrome. In addition to improving underlying sleep disorders, the treatment of "bromyalgia has focused on the use of antidepressants, muscle relaxants, and exercise programs. Treatment efforts have been largely unsuccessful because the use of antidepressants, exercise programs, and cognitive behavioral therapy has shown only short-term improvement or mild effectiveness (see Hawley & Wolfe, 2000, for a review). The diagnosis and treatment of "bromyalgia have been controversial because some researchers and health care providers believe the disorder is primarily psychological as opposed to physical. However, not all patients with "bromyalgia have comorbid psychiatric symptomatology or disorders. Furthermore, because the diagnosis of "bromyalgia is based solely on self-reported complaints of pain, women with this disorder may experience minimization or trivialization of their symptoms by health care providers. An interdisciplinary team approach is recommended to address the multiple problems and offer treatment options. Further research is warranted into ethnic-racial differences, etiology, diagnosis, and treatment of this disease. Health psychologists can assist in screening for mental health disorders in this population, as well as in teaching women to recognize the relationship between physical and psychological symptoms, use relaxation techniques in response to pain, and manage stressors and psychosocial dif"culties related to their symptoms. Osteoporosis Foundation (2001), 28 million Americans age 50 and older have osteoporosis or are at risk of developing the disease, which accounts for more than 1. The risk factors for osteoporosis include being female, having a small frame, older age, and family history. Research also indicates that caffeine intake, alcohol intake, cigarette smoking, and lack of exercise can be associated with lower bone mass resulting in higher risk of fracture (KaplanMachlis & Bors, 2000). Prevention and treatment efforts often focus on decreasing the risk of fracture, but prevention efforts educating women about the importance of calcium intake in the prevention of osteoporosis may be the most productive in decreasing women·s mortality. Health psychologists may be able to assist with osteoporosis prevention through the development of effective national awareness programs for women and children. Given the fact that women with substance use disorders are more likely to experience severe physical and mental health effects, we also present relevant data on nicotine and alcohol use. Further research addressing gender differences, the etiology of these disorders, and prevention strategies for these mental health problems in women is needed. Depressive Disorders Depression is a serious health problem for women; in fact, it has been reported as the leading cause of disability for women worldwide (C. Although gender differences begin to emerge with the onset of puberty, the average age of onset of major depression is approximately 25 years, with Osteoporosis Osteoporosis is a debilitating disease characterized by the loss of bone mass, which often leads to bone fractures. The most common fractures occur in the hip, spine, or wrist and can cause severe disability or death. The disease occurs in older women four times more often than in men of comparable age (Wisocki, 1998).

Posttraumatic stress disorders as a consequence of toxic spills were found in several studies treatment 002 cheap 5mg oxytrol. War and Genocide A section about disasters caused by humans cannot be concluded without mentioning the most terrible disasters that continue to happen daily at some place in the world treatment hemorrhoids cheapest generic oxytrol uk, namely, war and genocide. Research on the health effects of stressful life events started with recording reactions to war experience. During the two world wars, psychiatrists examined shell shock and battle fatigue among soldiers. Long-term effects of the Holocaust and the wars in Vietnam and Korea were studied as well. Posttraumatic stress disorder is one of the most frequently addressed phenomena in this line of research. Studies focus mainly on speci"c aspects of the war experience rather than the event as a whole. For example, there is a large body of research literature on torture victims (Neria, Solomon, & Dekel, 2000), Holocaust survivors. There is overlap with studies on migration effects, since ethnic con"icts, combat, and political persecution are among the most common reasons for people to emigrate. Psychological and physical impairment can transpire even decades after the traumatic experience. Landau and Litwin (2000) compared a community-based sample of Holocaust survivors at age 75 and older with control persons of a similar age and sociocultural background. The "ndings suggest that extremely traumatic events have long-lasting effects on the victims. However, the authors did not "nd evidence for generally higher rates of hypertension, diabetes, myocardial infarction, alcoholism, and other psychiatric disorders. Within the study group, those former prisoners who had suffered massive weight loss demonstrated a greater number of psychiatric disorders than their comrades. More evidence for the long-term effects of trauma comes from a study by Desivilya, Gal, and Ayalon (1996), who investigated the effects of early trauma in adolescence for victims· mental health and adaptation in later life. The critical incident took place in 1974 in a small town close to the border of Israel and Lebanon, when hundreds of hostages were taken during a terrorist attack, most of them adolescents. Participants in the study displayed signi"cantly more health problems 17 years later than the nontraumatized individuals in the control group. Also, survivors of the early traumatic event later showed greater vulnerability to psychological dif"culties when Israel was attacked by Iraqi Scud missiles in 1991 (see also Ben-Zur & Zeidner, 1991; Zeidner & Hammer, 1992). These studies, together with other empirical evidence on the effects of traumatic events, underline the importance of long-term observation of health outcomes in traumatized individuals in facilitating appropriate intervention and rehabilitation programs beyond acute needs for help. Conjugal Loss and Bereavement Experiencing loss is one of the major factors in the explanation of stress reactions. This section focuses on conjugal loss and the health effects resulting from bereavement. Considering the frequency and likelihood of such an event among those who have close longterm relationships, the relevance of research in this "eld becomes evident. In fact, the only way to protect yourself from that experience is to die either before or at the same time as the partner. The effects of bereavement on morbidity and mortality have been widely studied (for an overview, cf. In particular, gender and age differences in responding to the death of a spouse have received most attention. A quarter of a century ago, Bartrop, Luckhurst, Lazarus, Kiloh, and Penny (1977) described immunological changes associated with conjugal loss. The death of a spouse is suspected to lead to increased mortality in response to diseases that are presumed to depress the immune function (reduced lymphoproliferative responses, impaired natural killer cell activity). It has not been demonstrated, however, that morbidity and mortality following conjugal loss are the direct results of stressor-induced changes in immune function (Ader, 2001). Considerable differences between widowers and widows regarding the physical and psychological reactions to an event as well as the coping strategies have been found. One set of studies suggests that men suffer more after losing their partner than women, whereas others report more health complaints of bereaved women. Miller and Wortman (in press) suggest examining the impact of loss for the spouse who is left behind. Although norms and values regarding self-determination and economic independence of women have greatly changed over the past decades, elderly couples are more bound to traditional roles.

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Moreover symptoms gallstones buy oxytrol with a mastercard, genetic engineering can introduce purely synthetic genes medications after stroke generic 5 mg oxytrol with amex, thus, for better or worse, expanding the range of possible genes to the frontiers of the human imagination. It is the consequences of the procedure, combined with the current lack of systematic assessment of potential risks, that give cause for concern, as detailed in subsequent sections. There is always risk of escape during contained use, either due to physical or biological "leakiness". However, for most current and envisioned applications, the benefits outweigh the risks when strong and well-designed containment strategies are employed. Reproduction, in contrast, is known as vertical gene transfer, because the genes are passed down through the generations from parent to offspring. It is true that horizontal gene transfer occurs in lower organisms relatively frequently ­ for example, between different species of bacteria. When they do this to a germline cell ­ a cell involved in reproduction (a sperm or egg cell) the genes for that virus are passed down to the offspring and become a permanent part of the genome of the descendants. It is supported by organic and sustainable agriculture groups worldwide, with objections mostly focusing on patenting issues. Similarly, "genetic modification" is sometimes wrongly used to describe tissue culture, a method that is used to select desirable traits or to reproduce whole plants from plant cells in the laboratory. Tissue culture can be used for many other purposes, including some safe and useful ones. Biotechnology is an umbrella term that includes a variety of processes through which humanity harnesses biological functions for useful purposes. This is evidence that such processes cannot be assumed to be benign and may be harmful. In nature, the question of whether any given example of horizontal gene transfer is beneficial or harmful is answered over long periods of co-evolution and natural selection. Natural breeding, on the other hand, uses the inherent genetic potential in plants and does not deliberately disrupt their gene regulation system. Conclusion Genetic engineering is different from natural/conventional plant breeding and poses special risks, as is recognized in national and international biosafety laws. Rome, Italy: World Health Organization/ Food and Agriculture Organization of the United Nations; 2009. Evidence for genomic rearrangements mediated by human endogenous retroviruses during primate evolution. But the genetic engineering and associated tissue culture processes are imprecise and highly mutagenic. They imply that they can insert a single gene with laser-like precision and insertion of that gene will have a single, predictable effect on the organism and its environment. But manipulating one or two genes does not just produce one or two desired traits. The unintended changes could include alterations in the nutritional content of the food, toxic and allergenic effects, poor crop performance, and the emergence and spread of characteristics that harm the environment. Even when changes are detected, they are often dismissed as irrelevant without further investigation. Even the worst chemical pollution diminishes over time as the pollutant is degraded by physical and biological mechanisms. Very infrequently, a specific mutation can benefit the functioning of the organism. Much more frequently, mutations can harm the organism, for example, by giving rise to birth defects and cancer. The insertion process is uncontrolled, in that the site of insertion of the foreign gene is random. Typically this blocks the expression of ­ "knocks out" ­ the natural gene, destroying its function. It is estimated that there is a 53­66% probability that any insertional event will disrupt a gene. Mutations caused by tissue culture Three steps of the genetic modification process take place while the host plant cells are being grown in a process called cell culture or tissue culture. In another example, a gene that plays a role in controlling biochemical reactions in the plant could be damaged, making the plant allergenic or toxic, or altering its nutritional value.

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Diseases

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