Risk factors environmental

Environmental risk factors also influence the development and course of drug problems. For instance, poverty has been linked to higher rates of drug problems, and impoverished neighborhoods usually have higher rates of drug abuse. In 

One area of research related to abuse or neglect has to do with how well a person fits within his or her social environment. One researcher, Marsha Linehan (1993), has talked about how a poor fit with the social environment (viz., not fitting into the family, school life, or other important social networks) may cause psychiatric problems if the poorness of fit causes the person to feel like an outsider or to feel constandy invalidated or put down. Many of my clients have told me that they have not felt part of their families or that they did not fit well into society in general, or have described themselves as black sheep. Abuse and neglect lead to an invalidating environment, but so can mismatches of personalities within families or mismatches of behavioral patterns with social norms. Furthermore, there is evidence that the way emotion is expressed in families can be associated with a poorness of fit that can influence the course of drug problems. 

Many of my clients have talked about this as contributing to the feeling that they did not belong or were not accepted in their families (see the discussion later in this chapter about familial factors). 

In addition, societal expectations about substance use seem to be related to the susceptibility of societal members to experience drug-related problems. Many respected researchers believe that exposure to responsible substance use in society early in life may promote more moderate substance use in those societies where such behavior is sanctioned. One striking example is the Netherlands, which legalized marijuana use in coffee shops two decades ago but currently has lower marijuana abuse rates than the United States. We have no idea whether this kind of societal exposure would work with more potent substances than marijuana, although the same results have been found for alcohol in France, which has a much lower cirrhosis rate than the United States even 

In addition to biological and environmental factors that influence the onset and course of drug-related problems, there also are many individual risk factors. These variables can include those related to a person s actions or behavior, those related to the way a person thinks, or those related to the experience of emotions. The next few sections will discuss in detail these personal variables that can be related to drug problems in some people. 

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Careful monitoring and preventative care of high-risk patients can begin once these patients are identified. Intrinsic, or host-related, risk factors for the development of pressure sores include age greater than 75 years, limited mobility, loss of sensation, unconsciousness or altered sense of awareness, and malnutrition. Extrinsic, or environmental, risk factors include pressure, friction, shear stress, and moisture.37,42... 

Fergusson DM, Fergusson JE. Horwood LJ, et al. 1988a. A longitudinal study of dentine lead levels, intelligence, school performance and behavior. Part I. Dentine lead levels and exposure to environmental risk factors. J Child Psychol Psychiatry 29 781-792. 

The cause of MS is not known, but most evidence points to an immunologically mediated disease with important genetic and environmental risk factors [ 1,2,7,8]. The evidence for an autoimmune process is largely circumstantial... 

The expression of emotions in inappropriate ways can cause a vicious cycle for a person. For example, expressing emotions inappropriately can cause problems with interpersonal relationships. If a person is perceived as emotionally awkward or volatile, others may go out of their way to limit contact with that person. The result maybe increased social isolation, which in turn may reinforce the belief by many clients with drug problems that they are social misfits (recall the earlier discussion about environmental risk factors). In addition, the disinhibiting effects of drugs may exacerbate emotional dysregulation, potentially making the dys-regulation that much worse. 

The etiologies of the autoimmune inflammatory diseases, OA, osteoporosis and crystal-deposition disease are still not known in exact details. This is in contrast with impressive molecular insights gained recently. However, there is consensus that manifestations of autoimmune diseases are precipitated by either acute and/or chronic interactions of genetic and environmental risk factors. 

Osteoarthritis proves to be a more complex disease than autoimmune disease, with multiple variable manifestations like knee, hip, hand, DIP, elbow, shoulder, and spinal joints OA, which have different risk factors. The etiology of OA is multifactorial with inflammatory, metabolic and mechanical causes. A number of personal and environmental risk factors, such as obesity, occupation, and trauma, may initiate various pathological pathways. OA comprises degeneration of articular cartilage together with changes in subchondral bone of the joint margins and mild intraarticular inflammation. 

Kendler, K.S., Walters, E.E., Neale, M.C., Kessler, R.C., Heath, A.C., and Eaves, L.J. (1995) The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Arch Gene Psychiatry 52 374—383. 

Wade, T, Martin, N.G., and Tiggeman, M. (1998) Genetic and environmental risk factors for the weight and shape concerns characteristic of bulimia nervosa. Psychol Med 28 761-771. 

Wade, T.D., Bulik, C.M., Neale, M., and Kendler, K.S. (2000) Anorexia nervosa and major depression an examination of shared genetic and environmental risk factors. Am J Psychiatry 157 469-471. 

For a summary of individual and environmental risk factors and protective factors in aggressive behavior in youth, see Tables 50.02a and 50.2b. 

Gerald van Belle holds joint appointments as professor in the Departments of Biostatistics and of Environmental and Occupational Health Sciences at the University of Washington. Dr. van Belle received his PhD in mathematical statistics from the University of Toronto. His research has focused on the use of statistics to study various environmental health issues, including exposure to pollutants in air and drinking water, and environmental risk factors for Alzheimer s disease. Dr. van Belle served as a member of the National Research Council Board on Environmental Studies and Toxicology and was a member of the Committee to Review EPA s Research Grants Program. 

These findings depict a very complex scenario wherein there are different players, among which amyloid and hyperphosphorylated tau have a pivotal role that is still unclear, while the contribution of genetic and environmental risk factors has been increasingly established as either predisposing or modulating entities. 

WHO estimates that over 30% of the global burden of disease can be attributed to environmental factors and that 40% of this burden falls on children under five years of age, who account for only 10% of the world s population (WHO, 2004a). At least three million children under five years of age die annually due to environment-related illnesses. Environmental risk factors act in concert and are exacerbated by adverse social and economic conditions, particularly poverty and malnutrition. 

Cancer is uncommon during the first two decades of life, but is nonetheless a substantial concern. In the United States, cancer is diagnosed in approximately 12 400 children and adolescents annually and is the most common cause of death from any kind of disease between 1 and 19 years of age. In the United States and other developed countries, lymphoid neoplasms (leukaemia, lymphoma) and cancers of the central nervous system are the most common paediatric malignancies. Other kinds of childhood tumours include embryonal tumours of the retina, sympathetic nervous system, kidney, and liver tumours of bone and soft connective tissues and certain gonadal neoplasms. Different kinds of cancer (e.g. carcinomas of liver or thyroid) may predominate in children in parts of the world where specific environmental risk factors are more prevalent. 

T. Koschinsky, C. J. He, T. Mitsuhashi, R. Bucala, C. Liu, C. Buenting, K. Heitmann, and H. Vlassara, Orally absorbed reactive glycation products (glycotoxins) an environmental risk factor in diabetic nephropathy, Proc. Natl. Acad. Sci. USA, 1997, 94, 6474-6479. 

B. Environmental risk factors for neural tube defects Fumonisms... 

Since results from studies with biomedical models indicate potential, there is of obvious interest in the effects of RA consumption in foods on the risk of atherogenesis in humans. The use of surrogate biomarkers for disease risk is more readily achievable for atherosclerosis than for cancer in humans and a number of genetic and environmental risk factors have been identified, with the relative abundance of the different lipoproteins being of primary importance (Lusis, 2000). To date, there have been no epidemiological studies that have examined the intake of CLA derived from foods with the risk of atherosclerosis. However, as discussed in Section 3.6.2.1, the challenge of adequately evaluating the effect of dietary intake of CLA from different food sources presents some special limitations. 

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