An Introduction to Medical Diagnosis (3)

Despite not actually having reading all that many books this year I’m way behind on blogging the books I’ve read, so I thought I might as well try to catch up a bit. You can find my previous coverage of the book here and here.

In this post I’ll cover the chapters about the musculoskeletal system, the endocrine system, and the breast.

“Disorders of the musculoskeletal system make up 20–25 per cent of a general practitioner’s workload and account for significant disability in the general population. […] The chief symptoms to identify in the musculoskeletal assessment are: *pain *stiffness *swelling *impaired function *constitutional [regarding constitutional symptoms, “Patients with arthritis may describe symptoms of fatigue, fever, sweating and weight loss”]. […] As a rule mechanical disorders (e.g. OA [Osteoarthritis], spondylosis, and tendinopathies) are worsened by activity and relieved by rest. In severe degenerative disease the pain may, however, be present at rest and disturb sleep. Inflammatory disorders tend to be painful both at rest and during activity and are associated with worsened stiffness after periods of prolonged rest. The patient may note that stiffness is relieved somewhat by movement. Both mechanical and inflammatory disorders may be worsened by excessive movement.”

“The lifetime incidence of lower back pain is about 60 per cent and the greatest prevalence is between ages 45 and 65 years. Over 90 per cent of low back pain is mechanical and self-limiting. […] Indicators of serious pathology in lumbar pain: ‘red flags’ of serious pathology that requires further investigation […] are: *presenting under age 20 and over age 55 years *prolonged stiffness (>6 weeks) *sudden onset of severe pain *pain that disturbs sleep (>6 weeks) *thoracic pain *nerve root symptoms – including spinal claudication (pain on walking resolved by rest), saddle numbness, and loss of bladder or bowel control *chronic persistent pain (>12 weeks) *weight loss *history of carcinoma.”

“Osteoarthritis is a chronic degenerative and mechanical disorder characterized by cartilage loss. It is the most common form of arthritis, estimated to affect 15 per cent of the population of the UK over the age of 55 years. It is second only to cardiovascular disease as a cause of disability. Weight-bearing joints are chiefly involved (e.g. facets in the spine, hip and knee). […] There is little evidence to link OA with repetitive injury from occupation, except perhaps knee bending in men. Dockers and miners have a higher incidence of knee OA.”

“Rheumatoid arthritis […] is the most common ARD [Autoimmune Rheumatic Diseases] and is characterized by the presence of a symmetrical destructive polyarthritis with a predisposition for the small joints of the hands, wrists and feet. It is more common in women than men and may present at any age though most often in the third to fourth decade. […] Onset is typically insidious and progressive pain, stiffness and symmetrical swelling of small joints occurs. Up to a third of patients may have a subacute onset with symptoms of fatigue, malaise, weight loss, myalgia, morning stiffness and joint pain without overt signs of swelling. A mono- or bilateral arthropathy of the shoulder or wrist may account for up to 30–40 per cent of initial presentations”

“[Osteoporosis] remains a significant cause of morbidity and mortality. Peak bone mass is usually achieved in the third decade and is determined by both genetic and environmental factors. After the age of 35 the amount of bone laid down is less than that reabsorbed during each remodelling cycle. The net effect is age-related loss of bone mass. Up to 15 per cent of bone mass can also be lost over the 5-year period immediately post menopause. Symptomless reduction in bone mass and strength results in an increased risk of fracture; it is the resulting fractures that lead to pain and morbidity. Major risk factors to be considered in osteoporosis are: *race (white or Asian > African Caribbean) *age *gender *family history of maternal hip fracture *previous low trauma fracture (low trauma defined as no greater than falling from standing height) *long-term use of corticosteroids *malabsorption disorders *endocrinopathies […] *inflammatory arthritis […] Other risk factors include: *low body mass index […] *late menarche and early menopause *nulliparity *reduced physical activity *low intake of calcium (below 240 mg daily) *excess alcohol intake *smoking *malignancy (multiple myeloma).”

“Infection may give rise to systemic inflammatory arthritis or vasculitis. The condition ‘reactive arthritis’ is also recognized. […] It is usually triggered by sexually transmitted infection such as with Chlamydia trachomatis. The acute inflammatory reaction is treated with NSAIDs and corticosteroids and often ‘burns out’ after 6–18 months [Had to read that one twice: 18 months…]. It may leave lasting joint damage. […] Septic arthritis constitutes an acute emergency. The presentation is usually one of a rapid onset of severe pain in a hot swollen joint, the pain so severe that the patient cannot bear for it to be touched or moved.”

“Focal pain, swelling, or a low trauma fracture in the spine or long bones should alert suspicion [of neoplasia]. Primary tumours of bone include the benign (but often very painful) osteoid-osteoma, chondromas, and malignant osteosarcoma. Metastatic carcinoma may be secondary to a primary lesion in the lung, breast, prostate, kidney or thyroid. Haematological malignancies including lymphomas and leukaemias may also lead to diffuse bone involvement.”

“Diabetes mellitus is becoming a major public health problem. This is particularly true for type 2 diabetes, the prevalence of which is increasing rapidly due to the association with obesity and physical inactivity. Much of the morbidity, and cost, of diabetes care is due to the associated complications, rather than directly to hyperglycaemia and its management. Thyroid disease and polycystic ovarian syndrome are also prevalent [endocrine] conditions. Most other endocrine disorders are uncommon”

“The classic triad of symptoms associated with diabetes mellitus consists of: *thirst *polyuria (often nocturia) *weight loss.
Many patients will also experience pruritus or balanitis, fatigue and blurred vision. Some people, particularly those with newly presenting type 1 diabetes diabetes mellitus (T1DM) or with marked hyperglycaemia in type 2 diabetes mellitus (T2DM), may have a ‘full house’ of symptoms, in which case it is generally not difficult to suspect the diagnosis. However, other patients, particularly those with only modestly elevated blood glucose concentrations in T2DM, will have fewer, milder symptoms, and some may be entirely asymptomatic. […] symptoms potentially suggestive of diabetes may have alternative causes, particularly in elderly people, for example, frequency and nocturia in an older man may be due to bladder outflow obstruction, and many medical disorders are associated with weight loss. The symptom complex of thirst, polydipsia and polyuria most commonly suggests a diagnosis of uncontrolled diabetes mellitus but can occur in other settings. Some patients taking diuretics will experience similar symptoms. A dry mouth, perhaps associated with drug usage (e.g. tricyclic antidepressants) or certain medical conditions (e.g. Sjögren’s syndrome), may lead to increased fluid intake in an attempt at symptom relief.”

“The blood glucose concentration at diagnosis is not useful as a guide to whether an individual patient has T1DM or T2DM. Patients with T1DM can be in severe ketoacidosis with a blood glucose less than 20 mmol/L, and even below 10 mmol/L on occasions, whereas T2DM can present with a hyperosmolar state with blood glucose levels over 50 mmol/L.”

“30–50 per cent of patients with newly diagnosed T2DM will already have tissue complications at diagnosis due to the prolonged period of antecedent moderate and asymptomatic hyperglycaemia. […] Diabetes mellitus is much more than a disorder of glucose metabolism. The complications of diabetes can affect many of the organ systems leading to associated cardiac, vascular, renal, retinal, neurological and other disorders.”

“Pain is one of the commonest presenting disorders in the female breast, occurring in both pre-and postmenopausal women. […] In most women, there is no obvious or serious underlying breast pathology present […] In males, pain is not uncommon in gynaecomastia (swelling of male breast). […] A discrete lump, nodularity or thickening is the next most common mode of presentation. Size may vary (frequently ‘pea-sized’), but can be large. Onset may be acute (several days) or longstanding (several months). Fluctuation with the menstrual cycle is common in young women. Pain and tenderness are features of cysts, less common with fibroadenomas (unless rapidly growing or phylloides tumours), uncommon with cancer, except with rapidly expanding, aggressive (grade 3) and inflammatory tumours. The commonest lump in women below 30 years is a fibroadenoma; in women 30–45 years, a cyst and those over 45 years, cancer. […] Careful assessment of a lump can indicate whether the breast lesion is benign or malignant: *if it is rounded, smooth, mobile, tense and tender it is most likely to be a cyst (30 to 45 years of age) *if it is rounded, smooth, mobile, firm and non-tender it is most likely to be a fibroadenoma (under 30 years of age) *malignant lumps are rare in women under 30 years and uncommon under 40 years (4 per cent of breast cancers). Cancers are usually irregular, firm or hard, with variable involvement of overlying skin or deeper structures.”

“Retraction (intermittent, partial or chronic) is often a concern to women. It can be idiopathic or associated with malignancy in the retroareolar region, but usually is seen in the postmenopausal breast and is secondary to glandular atrophy and replacement by fibrosis and major duct ectasia. Congenital absence is very rare, whereas accessory nipples are seen in 2 per cent of women.” [Again, I had to read that one twice. 2 %! Who knew! Also, this condition seems to be even more common in males (see the link above).]

“Five to 10 per cent of women will, at some stage, present with a macrocyst. Microcysts are more common but tend to be occult. Breast cysts are commonest between the ages of 35 and 50, but can occur outside this age range, particularly in women who have been taking HRT. […] Patients present with a palpable lump or nodularity. When acute and large, the lump can be tender and the patient complains of pain. Typically cysts are well-circumscribed, smooth, mobile and, on occasion, tender lumps.”

“Nipple discharge in premenopausal women is likely to be associated with, or be due to, benign disease. It is the predominant clinical feature in up to 10 per cent of women presenting with breast cancer. […] *Purulent and coloured discharges are usually indicative of benign disease (infection and fibrocystic disease, respectively). *Spontaneous bilateral milky discharge (multiple ducts) most commonly occurs in women of reproductive age and is called galactorrhoea. […] *Clear, serous or bloodstained discharges are not infrequently associated with neoplastic disease”

“Carcinoma of the breast is one of the most common cancers (23 per cent of all female malignancies in the developed world) […]. One in 10 women develops breast cancer during her lifetime. […] Breast cancer is very rare in women under the age of 25. About 4 per cent occur under the age of 40. There is a plateau in incidence between the ages of 45 and 55, and beyond 55 years it continues to increase steadily into the 80s. […] The most common (70 per cent) presentation is a palpable lump, nodularity or thickening in the breast, usually detected by the patient. Typically the lump is firm or hard, well defined, with an irregular surface. […] About 25 per cent of women in the UK present with large primary tumours […], or locally advanced breast cancers […]. In some cases, particularly elderly patients, the tumour may have been present for some time, but hidden by the patient from her relatives due to fear and anxiety […]. Occasionally patients may even deny the presence of a tumour as a psychological coping strategy. […] Breast cancer is the most common malignant condition occurring during pregnancy. The incidence is approximately 1 in 2500 pregnancies, and poses many medical and psychological problems, both for the woman and her relatives.”

March 24, 2015 Posted by | books, cancer, diabetes, medicine | Leave a comment

Stuff/Links/Open Thread

i. National Health Statistics Reports, Number 49, March 22, 2012 – First Marriages in the United States: Data From the 2006–2010 National Survey of Family Growth.

“This report shows trends and group differences in current marital status, with a focus on first marriages among women and men aged 15–44 years in the United States. Trends and group differences in the timing and duration of first marriages are also discussed. […] The analyses presented in this report are based on a nationally representative sample of 12,279 women and 10,403 men aged 15–44 years in the household population of the United States.”

“In 2006–2010, […] median age at first marriage was 25.8 for women and 28.3 for men.”

“Among women, 68% of unions formed in 1997–2001 began as a cohabitation rather than as a marriage (8). If entry into any type of union, marriage or cohabitation, is taken into account, then the timing of a first union occurs at roughly the same point in the life course as marriage did in the past (9). Given the place of cohabitation in contemporary union formation, descriptions of marital behavior, particularly those concerning trends over time, are more complete when cohabitation is also measured. […] Trends in the current marital statuses of women using the 1982, 1995, 2002, and 2006–2010 NSFG indicate that the percentage of women who were currently in a first marriage decreased over the past several decades, from 44% in 1982 to 36% in 2006–2010 […]. At the same time, the percentage of women who were currently cohabiting increased steadily from 3.0% in 1982 to 11% in 2006– 2010. In addition, the proportion of women aged 15–44 who were never married at the time of interview increased from 34% in 1982 to 38% in 2006–2010.”

“In 2006–2010, the probability of first marriage by age 25 was 44% for women compared with 59% in 1995, a decrease of 25%. By age 35, the probability of first marriage was 84% in 1995 compared with 78% in 2006–2010 […] By age 40, the difference in the probability of age at first marriage for women was not significant between 1995 (86%) and 2006–2010 (84%). These findings suggest that between 1995 and 2006– 2010, women married for the first time at older ages; however, this delay was not apparent by age 40.”

“In 2006–2010, the probability of a first marriage lasting at least 10 years was 68% for women and 70% for men. Looking at 20 years, the probability that the first marriages of women and men will survive was 52% for women and 56% for men in 2006–2010. These levels are virtually identical to estimates based on vital statistics from the early 1970s (24). For women, there was no significant change in the probability of a first marriage lasting 20 years between the 1995 NSFG (50%) and the 2006–2010 NSFG (52%)”

“Women who had no births when they married for the first time had a higher probability of their marriage surviving 20 years (56%) compared with women who had one or more births at the time of first marriage (33%). […] Looking at spousal characteristics, women whose first husbands had been previously married (38%) had a lower probability of their first marriage lasting 20 years compared with women whose first husband had never been married before (54%). Women whose first husband had children from previous relationships had a lower probability that their first marriage would last 20 years (37%) compared with first husbands who had no other children (54%). For men, […] patterns of first marriage survival […] are similar to those shown for women for marriages that survived up to 15 years.”

“These data show trends that are consistent with broad demographic changes in the American family that have occurred in the United States over the last several decades. One such trend is an increase in the time spent unmarried among women and men. For women, there was a continued decrease in the percentage currently married for the first time — and an increase in the percent currently cohabiting — in 2006–2010 compared with earlier years. For men, there was also an increase in the percentage unmarried and in the percentage currently cohabiting between 2002 and 2006–2010. Another trend is an increase in the age at first marriage for women and men, with men continuing to marry for the first time at older ages than women. […] Previous research suggests that women with more education and better economic prospects are more likely to delay first marriage to older ages, but are ultimately more likely to become married and to stay married […]. Data from the 2006–2010 NSFG support these findings”

ii. Involuntary Celibacy: A life course analysis (review). This is not a link to the actual paper – the paper is not freely available, which is why I do not link to it – but rather a link to a report talking about what’s in that paper. However I found some of the stuff interesting:

“A member of an on-line discussion group for involuntary celibates approached the first author of the paper via email to ask about research on involuntary celibacy. It soon became apparent that little had been done, and so the discussion group volunteered to be interviewed and a research team was put together. An initial questionnaire was mailed to 35 group members, and they got a return rate of 85%. They later posted it to a web page so that other potential respondents had access to it. Eventually 60 men and 22 women took the survey.”

“Most were between the ages of 25-34, 28% were married or living with a partner, 89% had attended or completed college. Professionals (45%) and students (16%) were the two largest groups. 85% of the sample was white, 89% were heterosexual. 70% lived in the U.S. and the rest primarily in Western Europe, Canada and Australia. […] the value of this research lies in the rich descriptive data obtained about the lives of involuntary celibates, a group about which little is known. […] The questionnaire contained 13 categorical, close-ended questions assessing demographic data such as age, sex, marital status, living arrangement, income, education, employment type, area of residence, race/ethnicity, sexual orientation, religious preference, political views, and time spent on the computer. 58 open-ended questions investigated such areas as past sexual experiences, current relationships, initiating relationships, sexuality and celibacy, nonsexual relationships and the consequences of celibacy. They started out by asking about childhood experiences, progressed to questions about teen and early adult years and finished with questions about current status and the effects of celibacy.”

“78% of this sample had discussed sex with friends, 84% had masturbated as teens. The virgins and singles, however, differed from national averages in their dating and sexual experiences.”

“91% of virgins and 52 % of singles had never dated as teenagers. Males reported hesitancy in initiating dates, and females reporting a lack of invitations by males. For those who did date, their experiences tended to be very limited. Only 29% of virgins reported first sexual experiences that involved other people, and they frequently reported no sexual activity at all except for masturbation. Singles were more likely than virgins to have had an initial sexual experience that involved other people (76%), but they tended to report that they were dissatisfied with the experience. […] While most of the sample had discussed sex with friends and masturbated as teens, most virgins and singles did not date. […] Virgins and singles may have missed important transitions, and as they got older, their trajectories began to differ from those of their age peers. Patterns of sexuality in young adulthood are significantly related to dating, steady dating and sexual experience in adolescence. It is rare for a teenager to initiate sexual activity outside of a dating relationship. While virginity and lack of experience are fairly common in teenagers and young adults, by the time these respondents reached their mid-twenties, they reported feeling left behind by age peers. […] Even for the heterosexuals in the study, it appears that lack of dating and sexual experimentation in the teen years may be precursors to problems in adult sexual relationships.”

“Many of the virgins reported that becoming celibate involved a lack of sexual and interpersonal experience at several different transition points in adolescence and young adulthood. They never or rarely dated, had little experience with interpersonal sexual activity, and had never had sexual intercourse. […] In contrast, partnered celibates generally became sexually inactive by a very different process. All had initially been sexually active with their partners, but at some point stopped. At the time of the survey, sexual intimacy no longer or very rarely occurred in their relationships. The majority of them (70%) started out having satisfactory relationships, but they slowly stopped having sex as time went on.”

“shyness was a barrier to developing and maintaining relationships for many of the respondents. Virgins (94%) and singles (84%) were more likely to report shyness than were partnered respondents (20%). The men (89%) were more likely to report being shy than women (77%). 41% of virgins and 23% of singles reported an inability to relate to others socially. […] 1/3 of the respondents thought their weight, appearance, or physical characteristics were obstacles to attracting potential partners. 47% of virgins and 56% of singles mentioned these factors, compared to only 9% of partnered people. […] Many felt that their sexual development had somehow stalled in an earlier stage of life; feeling different from their peers and feeling like they will never catch up. […] All respondents perceived their lack of sexual activity in a negative light and in all likelihood, the relationship between involuntary celibacy and unhappiness, anger and depression is reciprocal, with involuntary celibacy contributing to negative feelings, but these negative feelings also causing people to feel less self-confident and less open to sexual opportunities when they occur. The longer the duration of the celibacy, the more likely our respondents were to view it as a permanent way of life. Virginal celibates tended to see their condition as temporary for the most part, but the older they were, the more likely they were to see it as permanent, and the same was true for single celibates.”

It seems to me from ‘a brief look around’ that not a lot of research has been done on this topic, which I find annoying. Because yes, I’m well aware these are old data and that the sample is small and ‘convenient’. Here’s a brief related study on the ‘Characteristics of adult women who abstain from sexual intercourse‘ – the main findings:

“Of the 1801 respondents, 244 (14%) reported abstaining from intercourse in the past 6 months. Univariate analysis revealed that abstinent women were less likely than sexually active women to have used illicit drugs [odds ratio (OR) 0.47; 95% CI 0.35–0.63], to have been physically abused (OR 0.44, 95% CI 0.31–0.64), to be current smokers (OR 0.59, 95% CI 0.45–0.78), to drink above risk thresholds (OR 0.66, 95% CI 0.49–0.90), to have high Mental Health Inventory-5 scores (OR 0.7, 95% CI 0.54–0.92) and to have health insurance (OR 0.74, 95% CI 0.56–0.98). Abstinent women were more likely to be aged over 30 years (OR 1.98, 95% CI 1.51–2.61) and to have a high school education (OR 1.38, 95% CI 1.01–1.89). Logistic regression showed that age >30 years, absence of illicit drug use, absence of physical abuse and lack of health insurance were independently associated with sexual abstinence.


Prolonged sexual abstinence was not uncommon among adult women. Periodic, voluntary sexual abstinence was associated with positive health behaviours, implying that abstinence was not a random event. Future studies should address whether abstinence has a causal role in promoting healthy behaviours or whether women with a healthy lifestyle are more likely to choose abstinence.”

Here’s another more recent study – Prevalence and Predictors of Sexual Inexperience in Adulthood (unfortunately I haven’t been able to locate a non-gated link) – which I found and may have a closer look at later. A few quotes/observations:

“By adulthood, sexual activity is nearly universal: 97 % of men and 98 % of women between the ages of 25-44 report having had vaginal intercourse (Mosher, Chandra, & Jones, 2005). […] Although the majority of individuals experience this transition during adolescence or early adulthood, a small minority remain sexually inexperienced far longer. Data from the NSFG indicate that about 5% of males and 3% of females between the ages of 25 and 29 report never having had vaginal sex (Mosher et al., 2005). While the percentage of sexually inexperienced participants drops slightly among older age groups, between 1 and 2% of both males and females continue to report that they have never had vaginal sex even into their early 40s. Other nationally representative surveys have yielded similar estimates of adult sexual inexperience (Billy, Tanfer, Grady, & Klepinger, 1993)”

“Individuals who have not experienced any type of sexual activity as adults […] may differ from those who only abstain from vaginal intercourse. For example, vaginal virgins who engage in “everything but” vaginal sex – sometimes referred to as “technical virgins” […] – may abstain from vaginal sex in order to avoid its potential negative consequences […]. In contrast, individuals who have neither coital nor noncoital experience may have been unable to attract sexual partners or may have little interest in sexual involvement. Because prior analyses have generally conflated these two populations, we know virtually nothing about the prevalence or characteristics of young adults who have abstained from all types of sexual activity.”

“We used data from 2,857 individuals who participated in Waves I–IV of the National Longitudinal Study of Adolescent Health (Add Health) and reported no sexual activity (i.e., oral-genital, vaginal, or anal sex) by age 18 to identify, using discrete-time survival models, adolescent sociodemographic, biosocial, and behavioral characteristics that predicted adult sexual inexperience. The mean age of participants at Wave IV was 28.5 years (SD = 1.92). Over one out of eight participants who did not initiate sexual activity during adolescence remained abstinent as young adults. Sexual non-attraction significantly predicted sexual inexperience among both males (aOR = 0.5) and females (aOR = 0.6). Males also had lower odds of initiating sexual activity after age 18 if they were non-Hispanic Asian, reported later than average pubertal development, or were rated as physically unattractive (aORs = 0.6–0.7). Females who were overweight, had lower cognitive performance, or reported frequent religious attendance had lower odds of sexual experience (aORs = 0.7–0.8) while those who were rated by the interviewers as very attractive or whose parents had lower educational attainment had higher odds of sexual experience (aORs = 1.4–1.8). Our findings underscore the heterogeneity of this unique population and suggest that there are a number of different pathways that may lead to either voluntary or involuntary adult sexual inexperience.”

iii. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil.

“Breastfeeding has clear short-term benefits, but its long-term consequences on human capital are yet to be established. We aimed to assess whether breastfeeding duration was associated with intelligence quotient (IQ), years of schooling, and income at the age of 30 years, in a setting where no strong social patterning of breastfeeding exists. […] A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula. […] From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identified dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (difference of 3,76 points, 95% CI 2,20–5,33), more years of education (0,91 years, 0,42–1,40), and higher monthly incomes (341,0 Brazilian reals, 93,8–588,3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the effect on income.”

This is a huge effect size.

iv. Grandmaster blunders (chess). This is quite a nice little collection; some of the best players in the world have actually played some really terrible moves over the years, which I find oddly comforting in a way..

v. History of the United Kingdom during World War I (wikipedia, ‘good article’). A few observations from the article:

“In 1915, the Ministry of Munitions under David Lloyd-George was formed to control munitions production and had considerable success.[113][114] By April 1915, just two million rounds of shells had been sent to France; by the end of the war the figure had reached 187 million,[115] and a year’s worth of pre-war production of light munitions could be completed in just four days by 1918.”

“During the war, average calories intake [in Britain] decreased only three percent, but protein intake six percent.[47]

“Energy was a critical factor for the British war effort. Most of the energy supplies came from coal mines in Britain, where the issue was labour supply. Critical however was the flow of oil for ships, lorries and industrial use. There were no oil wells in Britain so everything was imported. The U.S. pumped two-thirds of the world’s oil. In 1917, total British consumption was 827 million barrels, of which 85 percent was supplied by the United States, and 6 percent by Mexico.”

“In the post war publication Statistics of the Military Effort of the British Empire During the Great War 1914–1920 (The War Office, March 1922), the official report lists 908,371 ‘soldiers’ as being either killed in action, dying of wounds, dying as prisoners of war or missing in action in the World War. (This is broken down into the United Kingdom and its colonies 704,121; British India 64,449; Canada 56,639; Australia 59,330; New Zealand 16,711; South Africa 7,121.) […] The civilian death rate exceeded the prewar level by 292,000, which included 109,000 deaths due to food shortages and 183,577 from Spanish Flu.”

vi. House of Plantagenet (wikipedia, ‘good article’).

vii. r/Earthp*rn. There are some really nice pictures here…

March 24, 2015 Posted by | Chess, demographics, history, IQ, papers | Leave a comment

The Psychology of Lifestyle (III)

Again, I refer to the first post in the series for general comments and observations related to the book‘s coverage. Below some more stuff from the book and some observations:

“92 per cent of men and 86 per cent of women in Britain drink alcohol (DoH 2002a).”

I sort of liked the chapter about alcohol more than I did at first after I’d yesterday read some stuff in Boccia et al. dealing with the same topic (their coverage is much poorer in regards to some key issues). When thinking about how to blog this chapter I was considering including a table from the book, table 5,1, in full, even if it’s rather large, but I decided against it as I might as well report what it’s talking about myself here. The observation that addiction and physical dependence should be treated as separate entities is not included in the coverage, although Clark & Treisman considered this to be a very important point to keep in mind (see also this post: “It is very important to realize that addiction and physical dependence are different phenomena with different underlying brain substrates”), but the coverage is still much more detailed than the public health review text alluded to above. It should be noted that some of the shortcomings of the chapter is presumably due to the intended scope of the coverage which makes the omission of some of the important distinctions seem understandable, sort of; the authors note early on that they mostly focus on volitional rather than dependent drinking, because the book deals with lifestyle behaviours over which individuals have some level of control (but if you’re covering smoking and illegal substance abuse in your book, why not cover dependent drinking as well? I still find their coverage of some of these issues sort of puzzling…). Anyway, table 5,1 includes the ICD-10 diagnostic criteria for alcohol dependence, and these criteria include (my bold):

Evidence of tolerance (need more alcohol to get the same effect); physiological withdrawal when alcohol use is reduced or ceased (or use of a closely related substance with the intention of relieving or avoiding withdrawal symptoms); persisting with alcohol use despite clear evidence of harmful consequences; preoccupation with alcohol use (important other pleasures/interests given up or reduced because of alcohol, much time spent on activities such as procuring alcohol, consuming it, or recovering from its effects); difficulty controlling drinking behaviour in terms of onset-, termination or level of use – evidenced by alcohol being consumed in larger amounts or over a longer period than intended, or by any unsuccessful effort or persistent desire to cut down; and lastly a strong desire or compulsion to use alcohol.

“The majority of people who drink alcohol have not been diagnosed as dependent drinkers. Orton (2001) reported that 7.5 per cent of men and 2.1 per cent of women in Britain in the 1990s could be classified as dependent on alcohol. […] Nonresponse bias is a particular problem in drinking surveys. […] Issues of response bias are a common concern and one that afflicts many of the lifestyle surveys reported throughout this text. […] An important issue for measurement of drinking is the validity and reliability of the instrument in question and unfortunately many widely used measures of alcohol consumption have not been tested for such psychometric properties. […] Probably the most convincing evidence that self-report measures of drinking in any one study do, at the very least, place people in an appropriate place on the drinking continuum compared to their peers is the relationship between self-reported drinking and proven increased risk for a number of alcohol related conditions (Room et al. 2005).”

“Men drink more alcohol than women and they are more likely to exceed their daily and/or weekly guidelines, even though those guidelines are higher than those recommended for women […]. This gender difference in alcohol consumption is consistently reported in the national surveys and elsewhere […] and furthermore is similar to the gendered drinking patterns of previous decades […] There are few clear socio-economic trends in alcohol consumption evident from the National Surveys”

“People under the influence of alcohol are more likely to behave aggressively and this can lead to physical violence that can harm themselves and others […]. Offenders are believed to be under the influence of alcohol in 46 per cent of incidents of domestic violence and 44 per cent of acquaintance violence. […] 15 per cent of rape victims recorded by the 2001 British Crime Survey were raped when they were under the influence of alcohol [I was actually really surprised the number was that low…] […] People under the influence of alcohol are also more likely to have accidents. […] The World Health Organisation (2002) estimates that 20 per cent of motor vehicle accidents worldwide are alcohol related.”

“Alcohol has been implicated in more than 60 medical conditions, predominantly with negative, but occasionally with positive, consequences […] the relationship between alcohol consumption and health is not always linear. […] Episodic heavy drinking, even when the overall volume of alcohol intake is low, has been found to increase the risk for a number of cardiovascular conditions. […] This association is physiologically consistent with the increased clotting, lower threshold for ventricular fibrillation and elevation of low density lipoproteins that occur after heavy drinking (Room et al. 2005). […] Breast cancer risk increases linearly with increased alcohol consumption: 10 grams of alcohol a day (an average UK unit) increases the relative risk of breast cancer by 9 per cent. A daily consumption of between 30 and 60 grams a day increases the relative risk by 41 per cent […] In England and Wales alcohol-related injury or illness accounts for 180,000 hospital admissions a year (HM Government 2007).”

“Alcohol serves an important social function. It enhances social integration and facilitates the development of relationships (Kuther and Timoshin 2003). It is hardly surprising that people drink most at a period in their lives [teen-age years, early twenties] which is normally associated with the development of stable adult relationships (Paglia and Room 1999). Increased levels of drinking in newly divorced people may be in part due to the breakdown of stable relationships and the desire to establish new relationships (HM Government 2007). Social isolation is a key factor in poor health outcomes […] so the positive social function of alcohol in enabling people to develop social relationships should not be overlooked.”

“In contrast to other lifestyle behaviours where social norms have been argued to play little or no part in the explanation for variations in behaviour, social norms are consistently reported to be useful in explaining variations in drinking behaviour”

“it is well established that the earlier a person starts to drink, smoke or use illegal drugs the higher the risk of later abuse […] There is evidence that people drink less if the price of alcohol increases […] and that those of particular concern, heavy drinkers and young people, both respond to price increases by drinking less […] Many interventions to encourage sensible drinking are aimed at adolescents and young people with the goal of preventing the establishment of unhealthy drinking habits. The rationale for a predominance of interventions for this age group includes the indisputable fact that young people are the heaviest drinkers in society […] Many early drinking interventions are educational in nature. In essence these are risk communication messages and the evidence from psychological research is that improving risk perceptions will have little impact on levels of drinking. Unsurprisingly then, there is little evidence that alcohol education and health promotion have any positive effect on drinking habits in Britain […] These campaigns are heard and understood because knowledge increases in targeted populations […] so it is not that the message is failing to reach the designated audience, rather the message has no impact on behaviour. […] Foxcroft et al. (2003) reviewed the effectiveness of programmes designed to prevent excessive drinking in young people. Worryingly, [they] found very little evidence that any of these programmes were effective. Among the studies with medium-term followup that met the methodological guidelines the majority, 19 studies, found no evidence of intervention effectiveness. Several of these studies had previously reported short-term effectiveness which demonstrates the importance of longer term follow-up. […] There are two concerns from these studies on early drinking interventions. First, there are a wealth of studies that report no reduction in any measure of drinking. Second, research has failed to consistently test and tease out what is effective.”

Next, smoking:

“There is considerable variation in the prevalence of smoking worldwide. In sub-Saharan Africa less than 10 per cent of the population smoke, whereas in Japan this figure rises to above 50 per cent, and in Indonesia 69 per cent, with almost three-quarters of the Vietnamese population smoking (Edwards 2004).” [I had no idea the numbers were that high anywhere… (and I’m perhaps slightly skeptical, in particular about the Japanese estimate; a 50+% smoking prevalence seems to not fit very well with the very high Japanese life expectancy)]

“Despite the health effects of smoking being known since the 1960s, and the health impact being publicised, some 12 million individuals still smoke in the UK: 25 per cent of men and 23 per cent of women (ONS 2007). These figures have shown a substantial decrease since the early 1970s: for example in the 1970s the comparable figures were 51 per cent of men and 41 per cent of women smoking.” [If you’re curious about Danish figures, I blogged some Danish alcohol and smoking stats some years back here (the post is in Danish)] […] smoking is the highest in the 20–24 year age group (about 36 per cent) and the lowest in the over 65 years (about 15 per cent). This reflects both the fact that many former smokers will have quit and also that about a quarter of smokers die before reaching retirement age (ONS 2007). […] in the UK it is suggested that annually some 120,000 people die as a result of their smoking habit (440,000 in the United States). Every year, tobacco smoking kills 5 million people worldwide (Perkins et al. 2008) […] Deaths caused by tobacco smoking in the UK are higher than the number of deaths caused by road traffic accidents (3,500), other accidents (8,500), poisoning and overdose (900), alcoholic liver disease (5,000), suicide (4,000) and HIV infection (250). Almost a half of all regular smokers will be killed by their habit. A man who smokes cuts short his life by 13.2 years and female smokers lose 14.5 years (ASH 2008).”

“It is usually teenagers who experiment with smoking, with very few smokers starting after the age of 25 years […]. There are a number of reasons why people start smoking, but these are mainly related to psychosocial motives […] One of the major reasons for experimenting with cigarettes is social pressure from peers or older siblings […] adolescents are more likely to smoke cigarettes if their parents smoke […] Research has also indicated that teenagers underestimate the health risk of smoking […] and they also believe that they will quit before they do themselves serious damage […]. Hence, they smoke in spite of knowing the health damage effects of smoking: they know of them, they just don’t think it will impact upon them. […] of all the lifestyle behaviours discussed in this book smoking has the simplest relationship with social class and is the only behaviour to demonstrate a totally linear relationship with class.”

“One of the major attempts to reduce smoking has been the introduction of graphic warning labels on cigarette packets or on posters and billboards. […] there is very little evidence of the success of this form of approach. When politicians are asked for the evidence of such approaches there is much filibustering and some reference to dated research which does not stand up to scrutiny (Ruiter and Kok 2005). […] the evidence can be described as, at best, insubstantial. […] there are a large number of studies that highlight that some type of in-person or telephone behavioural support with NRT [nicotine replacement therapy] increases quit rates, especially those using nicotine gum […]. This support works by increasing motivation for quitting and remaining tobacco-free. However, most quitters attempt to stop smoking by use of NRTs alone and overlook the behavioural and psychological support required to enhance and maintain the necessary motivation”

The stuff below is from the smoking chapter, but might easily have been found in a very different chapter (or even in a different book?):

“Motivational interviewing can be defined as ‘a client-centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence’ (Miller and Rollnick 2002). Motivational interviewing has as its goal the simple expectation that increasing an individual’s motivation to consider change rather than showing them how to change should be the key step. If a person is not motivated to change then it is irrelevant if they know how to do it or not. […] Motivational interviewing (MI) is a technique based on cognitive-behavioural therapy which aims to enhance an individual’s motivation to change health behaviour. The whole process aims to help the patient understand their thought processes and to identify how their thought processes help produce the inappropriate behaviour and how their thought processes can be changed to develop alternative, health-promoting behaviours. Motivational strategies include eight components that are designed to increase the level of motivation the person has towards changing a specific behaviour. […] The eight components are: *giving advice (about specific behaviours to be changed) *removing barriers (often about access to particular help) *providing choice (making it clear that if they choose not to change that is their right and it is their choice […] *decreasing desirability (of the ambivalence towards change or the status quo) *practising empathy *providing feedback […] *clarifying goals (feedback should be compared with a standard (an ideal) *active helping”.

“The definition of ‘lapse’ and ‘relapse’ has been debated in various forums […] but simply a ‘lapse’ is a slip into smoking behaviour, whereas ‘relapse’ refers to long-term failure. Most smokers who attempt to quit do so through self-quitting […] but the rates of success are very low with reports suggesting that only about 3–5 per cent of those self-quitting attain long-term abstinence at 6–12 months (Hughes et al. 2004). More recently, self-quitters have been aided by being able to purchase over the counter NRT and although this can double the rate of success this is still a paltry 6–10 per cent success rate. […] Although the majority of smokers want to stop smoking and predict that they will have stopped in twelve months, only 2–3 per cent actually stops permanently a year (Taylor et al. 2006).”

Unsafe sex:

“In London, the area with the highest prevalence of HIV in the UK, 30 per cent of people did not know HIV could be transmitted through unprotected sex (National AIDS Trust 2006; UNAIDS 2006). [first thought: Some of these have got to be joke responses] […] [in the UK] the number of women diagnosed with HIV has increased in recent years and in 2007 it was some 40 per cent of the total (compared to 10 per cent of all diagnoses in 1990). […] 95 per cent of 16–24 year olds who use a condom do so in order to prevent pregnancy whereas only 71 per cent report using a condom in order to prevent infection. Furthermore, less than half (48 per cent) of men and only 37 per cent of women report using a condom ‘always’. […] At least 50 per cent of sexually active men and women acquire genital HPV infection at some point in their lives […] Regarding HIV it is estimated that one-quarter of people living with the disease do not know that they have it and are therefore at risk of transmitting the virus to others (CDC 2006e).”

“The pharmacological effects of alcohol and various other non-prescription substances tend to have the effect of reducing inhibitions, boosting confidence, intensifying emotions and increasing the importance of immediate cues such as sexual desire, at the expense of more future-oriented considerations such as STIs. As a result, users have been shown to engage in more risky sexual behaviours [related link (well, sort of related – if you skip the first paragraph and see link i. and ii…)] […] Alcohol use and sexual activity often co-occur and more than one-quarter of sexually active teens used alcohol or drugs during their last sexual experience […] However, not only does the condom have to be used, but also it has to be used effectively (i.e. properly). Hatherall et al. (2007) report that a sizeable minority (between 12 and 40 per cent) applied a condom imperfectly. […] it is well documented that the earlier first sex occurs the less likely it is that contraception will be used […] Reviews have shown that school-based sex education leads to improved awareness of risk and knowledge of protection strategies, and increases intention to adopt safer sex behaviours. It has also been found to delay sexual debut (Kirby et al. 2006).”

March 24, 2015 Posted by | alcohol, books, medicine, Psychology | Leave a comment