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Every cell in your discovery of the twisting body except for eggs discount kamagra chewable online mastercard impotence in the bible, sperm and red blood cells ladder structure isn’t just contains a full set of chromosomes in its nucleus buy 100mg kamagra chewable amex impotence and depression. It taught were connected in this way order online kamagra chewable impotence in young men, it would stretch them that the two connected approximately 67 billion miles! P Nucleotide S C 8 National Institute of General Medical Sciences Copycat It’s astounding to think that your body consists of trillions of cells. Each strand becomes cellular spell­checker catches and corrects nearly a pattern, or template, for making a new strand, all of these errors. The trouble is that most of these G C T A drugs do affect normal cells that grow and T A divide frequently, such as cells of the immune system and hair cells. A T G C Most of your cells are called diploid G C A T (“di” means two, and “ploid” refers to sets of A T chromosomes) because they have two sets of chromosomes (23 pairs). Each G C C G G C haploid cell has only one set of 23 chromosomes C G so that at fertilization the math will work out: A T A T A haploid egg cell will combine with a haploid sperm cell to form a diploid cell with the right A T number of chromosomes: 46. Matching chromosomes pair up This creates a mix of new genetic Chromosomes swap material in the offspring’s cells. Her research shows What happens if an egg or a sperm cell gets how, in healthy cells, gluelike protein complexes the wrong number of chromosomes, and how called cohesins release pairs of chromosomes at often does this happen? One of every 18 babies born to women over 45 has three copies of chromosome 13, 18 or 21 instead of the normal two, and this improper balancing can cause trouble. To make her work easier, Amon—like many other basic scientists—studies yeast cells, which separate their chromosomes almost exactly the same way human cells do, except that yeast do it much faster. Cells can look and act differently, and do entirely different jobs, because each cell “turns on,” or expresses, only the genes appropriate for what it needs to do. The New Genetics I How Genes Work 13 The biggest obstacle to learning more But our understanding is improving fast, has been a lack of tools. Roger Kornberg of Stanford University in the many pieces of this amazing, living machine California used such methods to determine the do what they do, and do it so well. The enzyme works much like a sections and then stitch only the exon pieces motor, Block believes, powered by energy released together (see drawing, page 15). Exon 1 Exon 2 Exon 3 Exon 4 Alternative splicing Exon 1 Exon 2 Exon 3 Exon 1 Exon 2 Exon 4 Translation Protein A Protein B 16 National Institute of General Medical Sciences Splicing has to be extremely accurate. An By cutting and pasting the exons in different error in the splicing process, even one that results patterns, which scientists call alternative splicing, in the deletion of just one nucleotide in an exon a cell can create different proteins from a single or the addition of just one nucleotide in an gene. Alternative splicing is one of the reasons intron, will throw the whole sequence out of why human cells, which have about 20,000 alignment. The result is usually an abnormal genes, can make hundreds of thousands of protein—or no protein at all. Until recently, researchers looked at genes, and Molecular biologist Christine Guthrie of the the proteins they encode, one at a time. Now, they University of California, San Francisco, wants can look at how large numbers of genes and pro­ to understand more fully the mechanism for teins act, as well as how they interact. Guthrie can identify right now, what’s going on in every cell of your which genes are required for splicing by finding body while you read a book or walk down the abnormal yeast cells that mangle splicing. Without introns, cells wouldn’t Using a technique called genome­wide need to go through the splicing process and keep location analysis, Richard Young of the monitoring it to be sure it’s working right. Massachusetts Institute of Technology unraveled As it turns out, splicing also makes it possible a “regulatory code” of living yeast cells, which for cells to create more proteins. This means that the Wtubes and petri dishes, state in which a baby the results have real consequences for is born determines the people. Your first encounter with genetic conditions for genetic analysis probably happened which he or she will be shortly after you were born, when a screened. Currently, doctor or nurse took a drop of blood states test for between from the heel of your tiny foot. Those born on Heritable Disorders in Newborns with this disorder and Children, which assists the Secretary cannot metabolize of the U. Department of Health and the amino acid Human Services, recommended a phenylalanine, standard, national set of newborn which is present tests for 29 conditions, ranging from in many foods. Done one gene at a time, used the results to identify genes that aren’t tran­ using methods considered state­of­the­art just a scribed correctly in people with the disease. He used a variation of the yeast how genes respond in diverse situations, researchers may be able to learn how to stop or jump­start genes on demand, change the course of a disease or prevent it from ever happening. The ribosome also links each additional amino acid into a growing protein chain (see drawing, page 13). In 1999, he showed how different parts she found, the nucleotides do something else of a bacterial ribosome interact with one entirely: They help the growing protein slip off another and how the ribosome interacts with the ribosome once it’s finished. Noller, Green and hundreds of other scientists These studies provided near proof that the work with the ribosomes of bacteria. For example, jobs for proteins is to control how embryos antibiotics like erythromycin and neomycin work develop. Scientists discovered a hugely important by attacking the ribosomes of bacteria, which are set of proteins involved in development by study­ different enough from human ribosomes that our ing mutations that cause bizarre malformations cells are not affected by these drugs. As researchers gain new information about The most famous such abnormality is a fruit bacterial translation, the knowledge may lead to fly with a leg, rather than the usual antenna, more antibiotics for people. Kaufman of Indiana University many bacteria have developed resistance to the in Bloomington, the leg is perfectly normal—it’s current arsenal. In this type of mutation and many others, It can be difficult to find those small, but critical, something goes wrong with the genetic program changes that may lead to resistance, so it is that directs some of the cells in an embryo to important to find completely new ways to block follow developmental pathways, which are bacterial translation. In the antenna­into­leg problem, strategy is to make random mutations to the it is as if the cells growing from the fly’s head, genes in a bacterium that affect its ribosomes. Using clever molecular tricks, Green figured Thinking about this odd situation taught out a way to rescue some of the bacteria with scientists an important lesson—that the proteins defective ribosomes so they could grow. Scientists determined that several different genes of different organisms, it’s a good clue genes, each with a common sequence, provide that these genes do something so important and these anatomical identification card instructions. In the early 1980s, he and yeast to plants, frogs, worms, beetles, chickens, other researchers made a discovery that has been mice and people. For example, in Antennapedia but in the several genes next to researchers have found that abnormalities in it and in genes in many other organisms. This technology has Microarrays are used to get clues about changed the way many geneticists do their work which genes are expressed to control cell, tissue by making it possible to observe the activity of or organ function. What newborn tests does your fluorescence at each spot on the chip, revealing area hospital routinely do? A computer analyzes the patterns of gene activity, providing a snapshot of a genome under two conditions (e. These discoveries reveal that it is truly a remarkable molecule and a multi ­ talented actor in heredity. The riboswitch shown here bends into a special shape when it grips tightly onto a molecule called a metabolite (colored balls) that bacteria need to survive. Utah School of Medicine in Salt Lake City studies Understanding the details of this process is an one particular class of editors called adenosine important area of medical research. Researchers investi­ awarded the Nobel Prize in physiology or gating genes involved in plant growth noticed medicine for their discovery. They have later, two geneticists studying development saw learned, for example, that the process is not limited a similar thing happening in lab animals.

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The region is the site of immunological activities due to the presence of numerous blood antigens 45 The remainder of the spleen consists of red pulp and is composed of sinusoids (modified blood vessels) and splenic cords (of Billroth) purchase kamagra chewable 100mg visa erectile dysfunction va disability rating. The latter are cellular regions organized as plates of loose lymphatic tissue separating the sinusoids cheap kamagra chewable generic creatine causes erectile dysfunction. It is not always possible to distinguish Billroth cords from the sinusoids purchase kamagra chewable 100mg without a prescription erectile dysfunction drugs list, as is evident in this preparation where the sinusoids are partially collapsed. The lining cells of these sinusoids are elongated endothelial cells with tapered ends that lie parallel to the long axis of the vessel. In cross sections of sinusoids, therefore, the lining reticular cells are cut transversely and appear as cuboidal blocks arranged loosely in a circle, with intervening gaps. In section, the membrane may be seen as a succession of black points or short lines of silver-impregnated substance. The cardiovascular system is composed of the heart and a continuous system of blood vessels including arteries, arterioles, capillaries, venules, and veins. The innermost layer is the tunica intima, which includes a single layer of cells lining the lumen called the endothelium. There are important histological differences in the composition of these layers within each component of this system, which will be explored later in this lab. Valve Ventricle Atrium #17 Heart, Monkey, Sagittal Section (Mallory-Azan) The epicardium includes a layer of simple squamous epithelium called the mesothelium and underlying supportive connective tissue. The epicardium is the outermost layer surrounding the heart, and is comparable to the tunica adventitia of vessels. In the region of the atrium the epicardium contains fatty connective tissue and vessels of the coronary circulation. The distribution of blue-staining collagen fibers reveals the fascicle organization of the myocardium, which is comparable to the tunica media. In areas where muscle 47 fascicles are longitudinally sectioned, note the intercalated discs which appear as red-staining step-like lines perpendicular to the long axis of the fiber. The endocardium contains an endothelium on the free surface and underlying supportive connective tissue. Conduction continues through the atrioventricular bundle of His and into Purkinje fibers of the ventricles. Purkinje fibers are hypertrophied cardiac muscle fibers that are specialized for conducting an impulse rather than for contraction. They contain one or two nuclei, centrally situated in a pale staining mass of sarcoplasm that is rich in mitochondria and glycogen. Major branches of the bundle of His lie outside the myocardium in the subendocardium, as seen on the right side of this slide. Purkinje fibers traverse the myocardium where the terminal From left to right: muscle fiber, connective tissue, branches merge into muscle fascicles. This purkinje fibers, connective tissue, muscle fiber is seen in favorable longitudinal sections as a point where the Purkinje fibers become smaller, more densely stained, and indistinguishable from fascicles of muscle fibers. Individual muscle fibers are grouped in fascicles that are seen in both cross and longitudinal section on this slide. The fascicles are bounded by connective tissue containing blood vessels of the coronary circulation and nerve fibers. Remember that red blood cells are often visible in the lumen of blood vessels, however they will not be present in every lumen due to preparation of the slides. Larger vessels have a common structural plan in that they are composed of three concentric coats or tunics. This consists of the endothelial lining and its basement membrane, and a delicate layer of loose subendothelial connective tissue. The nuclei of the simple squamous epithelial cells of the endothelium protrude into the lumen of the vessel. In arteries and arterioles, an internal elastic membrane delimits the outer margin of the tunica intima. This coat consists predominantly of fibroelastic connective tissue whose fibers generally occur in a longitudinal array. In larger muscular arteries, there is frequently an external elastic membrane separating the tunica adventitia from the tunica media. Arteries have an internal elastic membrane (although it is less distinctive in large elastic arteries). It is predominantly muscular in arterioles and most arteries, but is predominantly elastic in the largest arteries (the so-called elastic arteries) such as the aorta and the common carotid. A useful generalization is that arteries have a relatively thick wall with a small lumen, whereas veins have a relatively thin wall and a broad lumen. Arterioles and small arteries exhibit a distinctive Artery top, vein bottom arrangement of endothelial cells and smooth muscle fibers in their walls. The endothelial cells are oriented longitudinally, whereas the smooth muscle fibers in the adjacent tunica media are wrapped around these vessels in a circular fashion. The Aorta The sections on these slides are stained to demonstrate elastin, collagen and the cellular organization of the aorta. The aorta is an elastic artery which has a relatively thick tunica intima bounded by endothelium and the internal elastic membrane. In the tunica intima smooth muscle cells run parallel to the long axis of the aorta while in the tunica media smooth muscle is spirally arranged. Within the tunica media the distribution of elastin in the elastic laminae is revealed as red-staining or black-staining material by the elastin stain. Elastin is not stained in the Masson preparations, but can still be seen as clear, refractile material surrounded by blue-staining collagen fibers. Both elastin and collagen are produced by smooth muscle cells, which are the only cell type within the tunica media. Tunica adventitia tunica media Tunica intima #16 Aorta, Rhesus monkey, Cross Section #20 Aorta, Cross Section (Elastin Stain) In slides #16 and #20 the blood vessels supply the aorta, the vasa vasorum, should be identified in the tunica adventitia. The major component of the wall of the artery is spirally arranged smooth muscle (therefore seen here in longitudinal section). Note that the nuclei are elongated and that due to contraction of the vessel wall, some of them appear corkscrew shaped. The nuclei are relatively euchromatic (as compared to those of fibroblasts in the adventitia of the vessel). The smooth muscle cells, in addition to contracting to control the diameter of the vessel, also produce collagen and elastic fiber components of the muscular part of the vessel wall. This laboratory exercise serves both as an introduction to the skin, the largest organ of the body, and as a review of the major tissues. As you study the slides of the skin, identify examples of epithelium, connective tissue, muscle and nerve. All skin is made up of three layers: Epidermis- stratified squamous keratinizing epithelium Dermis – a superficial papilllary layer of loose connective tissue, underlain by a reticular layer of dense fibrous irregularly arranged connective tissue Hypodermis – deepest layer of skin, also called subcutaneous tissue, made up of loose connective tissue and adipose tissue #4 Skin, thick skin, volar surface H&E Epidermis: The stratified squamous keratinizing epithelium of the epidermis is made up primarily of keratinocytes.

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Another method of measuring (2 each) the output of diabetes researchers is the • Biochemistry discount kamagra chewable 100mg line zocor impotence, Physical Education and number of publications in the scientific Surgery (1 each) cheap kamagra chewable 100 mg online erectile dysfunction signs. Of these buy kamagra chewable discount erectile dysfunction 60, 70% were basic, appointments in more than one 12% clinical and 18% community-based department and the affiliation of non-first diabetes research. Vincent Declaration betes care in the Americas, with the adop- identified diabetes as a major and growing tion of the Declaration of the Americas on European health problem, a problem at all Diabetes in 1996. In 1996, camp for children with diabetes, resource 348 research grants were awarded to centres, development of standards for scientists in 15 countries on four continents, peer support groups and co-ordination of including three Canadian provinces. Most research and discrimination of people with diabetes, programs are based on individual health as ensuring access to care and services and opposed to population health. Branch, which provides national The Canadian Diabetes Advisory Board leadership in policy development, health sponsored a workshop in October of 1994 research and system enhancement to to develop strategies to address the issues preserve and improve the health and related to diabetes in Canada. More • 3rd International Conference on Diabetes than 170 key stakeholders, including and Indigenous Peoples: Theory, Reality, consumers, healthcare professionals, Hope, May 26-30, 1995, Winnipeg, business leaders and government Canada. The delegates Association was established in 1995 came together to identify priorities, develop after the 3rd International Conference on action plans and discuss strategies to build Diabetes and Indigenous Peoples in an effective and efficient national model of Winnipeg, Manitoba. Some national and • The National Aboriginal Diabetes Strategy international initiatives to address this issue Discussion Paper, co-ordinated by the include: Medical Services Branch of Health Canada. The Southern Aboriginal Diabetes Initiative is a service developed to improve quality of care to Aboriginal people living with diabetes in southern Ontario. Refers to all Aboriginal groups including ownership of decision-making and resources as these Status, Non-Status First Nation people, Metis and pertain to its own betterment. This process is performed externally, either that provides health and social services on an through the blood (hemodialysis) or through the ambulatory and outreach basis using multi-disciplinary delicate linings inside the abdomen (peritoneal teams of health care providers and volunteers. The term “incidence” is sometimes used to children of a household head who has not denote incidence rate. Manitoba Health makes this determination for adults based on self-report of an individual (typically at the time when Manitoba Health numbers are issued). In the case of dependent children, this determination is automatically made for any children in a household when the household-head has made a declaration of entitlement under “The Indian Act” for themselves, or their children. The description “status” has been adopted to denote this population, although this specific phrase is not defined by “The Indian Act. Occurs most often in adults, previously called Maturity-Onset Diabetes and Non-Insulin-Dependent Diabetes. This form of dia- betes can be controlled with a combination of lifestyle changes, pills and/or insulin. A Planning Framework to of Health and Human Services, Centers for Disease Promote, Preserve and Protect the Health of Control and Prevention. Efficacy Welfare, First Nations’ Health Commission - Assembly of atenolol and captopril in reducing the risk of of First Nations, Canadian Diabetes Association. The Kahnawake Schools Diabetes Prevention Project: Intervention, Evaluation, and Baseline Results of a Diabetes Primary Prevention Program with a Native Community in Canada. Morna Cook Unit Consultant Canada Prenatal Nutrition Program Pharmacy Consultant Diabetes and Chronic Diseases Unit Healthy Start for Mom and Me Canadian Diabetes Association Public Health Branch, Manitoba Health Wylie, Ms. Sandy Interlake Regional Health Authority Inc Department of Opthalmalogy Liaison, Health Program & Operations Novak, Mr. F etal:9 weeksto birth F irsteigh tweeksare furth er divided into 23 stages Stage one (day one) corresponds to fertiliz ation S ignificance • K nowledge ofdevelopmentofdifferentorgans,tissuesand systems. C om m onterm sused inem bryology • O ocyte (O vum)- amature secondary oocyte ready for fertiliz ation. C om m onterm sused inem bryology th • F etus-fetalperiod isfrom 9 week tillbirth wh ich is marked by differentiation,growth oftissuesand organsand subsequentweigh tgain. W ith more differentiationand growth ,th e structure gradually ch angesto primary, secondary ordefinitive etc. G am etogenesis • Processofformationand developmentofspecializ ed generative cells– gamete • Preparessexcellsforfertiliz ation M eiosis • Producesh aploid gametes • A llowsrandom assortmentofmaternaland paternalch romosomesbetweenth e gametes • C rossingoverofch romosome segments-produces arecombinationofgeneticmaterial N ondisjunction-ch romosomally abnormalgametes • Inm ale th e sexorgansare th e testes wh ich produce sperm atoz oa(m ale gam etesorsperm s),44xy. O ogenesisV sS perm atogenesis S im ilarities • P G C originate from th e sam e source and atth e sam e tim e. Secretory (progestational)-C h angesinfluenced by th e progesterone secretioninth e corpusluteum ofovary ( afterovulation). Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. The guidance does not, however, override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. The nutrition guidelines are relevant to people at high risk of developing Type 2 diabetes and people with Type 1 and Type 2. The criteria for the grading of recommendations in this document are based upon a paper by Petrie et on behalf of the Scottish Intercollegiate Guidelines Network. A criticism often made about new guidelines is that they fail to acknowledge previous or competing guidelines. These guidelines address this by adopting a system of signposting relevant, current guidelines for each section and these are highlighted by the following symbol:a Evidence-based nutrition guidelines for the prevention and management of diabetes 5 2. The purpose of these guidelines is to provide information to healthcare professionals and people living with diabetes about nutritional interventions that will assist them in making appropriate food choices to reduce risk and improve glycaemic control and quality of life, in relation to their diabetes. Advice needs to be based on scientific evidence and then tailored specifically for the individual, taking into account their personal and cultural preferences, beliefs, lifestyle and the change that the individual is willing and able to make. Achieving nutrition related goals requires a co-ordinated team approach, with the person with diabetes at the centre of the decision making process. A registered dietitian with specialist knowledge should take the lead role in providing nutritional care. However, it is important that all members of the multi-disciplinary team are knowledgeable about diabetes-related nutrition management and support its implementation. The beneficial effects of physical activity in the prevention and management of diabetes and the relationship between physical activity, energy balance and body weight are an integral part of lifestyle counseling and have been discussed in this document. Culturally appropriate health education is more effective than the ‘usual’ health education for people from ethnic minority groups. Educational visual aids are effective tools to support diabetes self-management and are useful when educating individuals whose frst language is not English or for those with sub-optimal literacy skills. Telemedicine is an acceptable and feasible form of communication and is another tool that can be used for patient education. There is consensus that person-centred care and self-management support are essential evidence-based components of good diabetes care resulting in better quality of life, improved outcomes and fewer diabetes-related complications. Nutrition management has shifted from a prescriptive one-size fts all approach to a person-centred approach. A person-centred approach puts the person at the centre of their care and involves assessing the person’s willingness and readiness to change, tailoring recommendations to their personal preferences and joint decision making. Training in patient-centeredness and cultural competence may improve communication and patient satisfaction, however, more research is needed to ascertain whether this training makes a difference to healthcare use or outcomes [21,22]. Evidence-based nutrition guidelines for the prevention and management of diabetes 7 Nutrition management and models of education A registered dietitian with expertise in diabetes care should be providing nutrition advice to all people with diabetes or at high risk of developing diabetes. Nutrition and weight management an area of concern for people with diabetes, with many requesting better access to a registered dietitian.

Psychological Risks It’s theoretically possible to take kids before Clinical mental health disorders such as they first drink cheap kamagra chewable online master card erectile dysfunction statistics age, find out whether they have any depression and anxiety and psychotic disorders gene variations discount kamagra chewable 100mg with amex erectile dysfunction medications causes symptoms, and say to them kamagra chewable 100mg generic erectile dysfunction 30 years old, ‘If you choose such as schizophrenia, as well as behavioral to be a drinker, then be careful because it’s very disorders such as conduct disorder and attention- likely that you’ll need to drink more to have the 58 50 deficit/hyperactivity disorder --and sub-clinical same effect. Individuals whose brain University of California, San Diego development has been altered by stress are more sensitive to the effects of addictive substances and more vulnerable to the development of Other Drugs. Twin military duty, are at increased risk of developing studies have found genetic risks for 62 addiction. People who have risk-taking or hallucinogen, opioid, sedative and stimulant use 63 impulsive personality traits or who have low 53 64 and addiction. Expectations play a role in substance use as well, since people who expect that using In addition to genetic variations, certain addictive substances will be a positive and individuals have neurological, structural or rewarding experience--in terms of physical functional differences that make them more effects, mood or behavior--are likelier to smoke, 54 susceptible to addictive substances. This is in drink alcohol or use other drugs than are those part due to individual differences in how the 67 with more balanced or negative expectations. Some research indicates that individuals with a Environmental Risks naturally low level of dopamine response to addictive substances are at increased risk of Many factors within an individual’s family, engaging in substance use in order to achieve a social circle and community, as well as the greater experience of reward. Other research larger cultural climate, increase the likelihood suggests that individuals with a biological that an individual will use addictive substances and develop addiction. The of cases, addiction originates with substance use 82 nature of the parent-child relationship is key; before the age of 21. Because the parts of the people who come from families with high levels brain responsible for judgment, decision- of parent-child conflict, poor communication, making, emotion and impulse control are not weak family bonds and other indicators of an fully developed until early adulthood, unhealthy parent-child relationship are at adolescents are more likely than adults to take 69 increased risk of substance use and addiction. At the same time, because these or convey approval of such use are at increased regions of the brain are still developing, they are 70 risk as well. Homes where liquor and combination of early initiation of use and medicine cabinets are open to teens increase the genetic, biological, psychological or 73 chances that teens will use these substances. Widespread access to controlled prescription drugs contributes to the misuse of these … [addiction] is not simply a disease of the 75 substances and increased access to marijuana brain, but it is a developmental disorder, and it 71 marketed as medicine is linked to increased begins early in life--during adolescence. Risky Use and Addiction Exposure to advertising and marketing messages Frequently Co-occur with Other that promote or glamorize smoking and drinking Health Conditions increases the chances that these substances will 78 be used and misused. Direct-to-consumer marketing of controlled prescription drugs may Individuals with addiction are likely to have co- 87 encourage substance use by conveying the occurring health conditions. Smoking causes 79 bladder, esophageal, laryngeal, lung and oral message that there is a pill for every ill. From 2000-2004, the top three causes Environmental influences can exacerbate of smoking-attributable death were lung cancer, existing genetic, biological and psychological risks for substance use, further increasing the * As is true of much of health research, the research chances that an individual will engage in risky on the neurological effects of addictive substances on substance use, sometimes to the point of 80 the adolescent brain primarily has been conducted on addiction. Alcohol consumption chronic disease--like heart disease, hypertension, contributes to diseases that are among the top diabetes and asthma--defined as having a clear causes of death, including heart disease, cancer biological basis, a behavioral component, 90 and stroke. Addiction involving alcohol is environmental influences, unique and linked to cirrhosis, alcoholic hepatitis, chronic identifiable signs and symptoms, a predictable pancreatitis, cardiomyopathy, heart arrhythmias, course and outcome and the need for continued 104 stroke and neoplasms of the liver, pancreas and management following treatment. Heavy alcohol use and addiction involving alcohol are associated with the Like any other chronic condition, addiction 92 incidence and re-infection of tuberculosis. The incidence of various forms of other chronic conditions, individuals with 94 95 cancer, heart disease and sexually-transmitted addiction can have symptom-free periods and 96 105 diseases are higher among those with addiction periods of relapse. In fact, Risky use and addiction also have high rates of addiction frequently is characterized as a disease co-occurrence with many mental health where relapse is virtually inevitable. Yet, this problems including depression, anxiety, post- conception of addiction might be due to the traumatic stress disorder, bipolar disorder, focus of research studies on those with the most schizophrenia and other neuropsychiatric severe manifestations of addiction, who disorders such as attention deficit/hyperactivity experience multiple episodes of symptom disorder, conduct disorder and eating relapse and co-existing health and social 98 disorders. The association between addiction problems over the course of many years or even 107 and co-occurring health conditions can result a lifetime. Substance use may addiction actually receive adequate, effective, 108 precipitate the onset of other conditions such as evidence-based treatment. Other times, high rates of relapse may be due, at least in the health conditions may precede the onset of part, to inadequate or ineffective interventions 109 addiction, as often occurs with mood disorders and treatments. It doesn’t mean types of conditions also may co-occur as a that the treatment doesn’t work, it just means function of an underlying psychological or 97 that you need to continue treatment. Boston University School of Medicine Addiction Can Be a Chronic Disease Once an individual develops addiction, changes in the brain’s reward circuitry may remain even 103 after cessation of substance use. These changes leave addicted individuals vulnerable to * physiological and environmental cues that they Relapse rates for those with addiction are have associated with substance use, increasing comparable to relapse rates for those with other chronic diseases. This approach has contributed to the critical because it influences how individuals concern that viewing addiction as a disease with addiction are treated in society and guides might: the nature of the services provided to address the 110 disease. The current model of addiction 111  Release the individual from personal recognizes that it is a complex brain disease responsibility and the need for self- and that multiple determinants and systems 119 control, and influence substance use and its progression to 112 addiction. Although this model is based on a  Engender feelings of hopelessness with large and growing body of scientific evidence, regard to effective treatment and the treatment practice and public attitudes still 120 possibility of recovery. These concerns, however, rarely are raised in 113 relation to other health problems and appear, at Since the 1700s, with few exceptions, two least in part, to be reflective of the moral model different models have dominated society’s views of addiction. Addiction The moral model of addiction framed addiction primarily as a failure of personal responsibility America’s approach to addressing substance use or morality. This approach has to effective marketing by the tobacco industry, contributed to: that view was replaced by one of tobacco use as 122 glamorous and even healthful, only to be  The stigma associated with addiction, supplanted in the mid-1960s by a growing attaching blame to the individual, creating understanding that cigarette smoking is a shame and embarrassment, increasing the significant contributor to poor health and 123 likelihood of discrimination and decreasing disease. Physicians prescribed marijuana and cocaine for th a variety of ailments in the late part of the 19  Restrictions in benefits for addicted century only to scale back in the first decades of th individuals. In response to the proliferation of including welfare, unemployment marijuana, hallucinogen, cocaine and heroin use assistance, job training, food stamps and in the late 1960s and early 1970s--and their 117 public housing on passing a drug test. This trend would ready the patient for treatment or actually toward criminalization was reflected in federal providing treatment and follow-up care; the and state laws such as New York’s Rockefeller guidelines also specify the actions and Drug Laws which created mandatory minimum knowledge required for each level of physician 134 sentences of 15 years to life for possession of involvement. In 1989, a third of a century four ounces of narcotics (about the same as a after declaring that alcoholism is a disease, the 127 sentence for second-degree murder). Comprehensive Alcohol underlying addiction and the development of Abuse and Alcoholism Prevention, Treatment, evidence-based pharmaceutical and psychosocial 139 and Rehabilitation Act of 1970 recognized therapies to treat it. Yet it was not until the alcoholism as “an illness requiring treatment and late 1990s that addiction began to gain broader 132 140 rehabilitation. The Council on The history of addiction as a brain disease looks Mental Health, its Committee on Alcoholism, and a lot like the history of atoms or germs, insofar the profession in general recognizes this syndrome as these were all older and controversial ideas of alcoholism as illness which justifiably should 133 for which scientific confirmation later became have the attention of physicians. However, highly th effective marketing campaigns conducted during the early and mid-20 century by the major tobacco companies tremendously enhanced the appeal of smoking for men and women alike. The image of the cigarette smoker projected by such campaigns--and by the entertainment media--was that of glamour, sophistication and even fitness. Some medical professionals even signed on to the health message; tobacco advertisements featured physicians and 142 some appeared in medical journals. In 1950, a landmark study linking smoking to lung cancer was published in 143 the prestigious Journal of the American Medical Association. Over the next decade, more than 7,000 articles were 144 published linking smoking with lung cancer and other life-threatening diseases. Surgeon General’s Report on Smoking and Health was published, concluding that smoking was hazardous to health and that 145 immediate action was warranted. The truth about the dangers of smoking and the health consequences of second-hand smoke, finally reached the public through unmistakable health evidence and powerful anti-tobacco health and legal campaigns. Perceptions of smoking (and smokers) largely turned negative, public policy shifted toward widespread bans and restrictions on smoking, and smoking rates have declined significantly. The duality of alcohol--as a staple for celebrations, religious rituals or relaxing with family and friends, and on the other hand as an underlying driver of crime, poverty, family dysfunction and illness--has a very long history.

G. Iomar. Jamestown College.