By W. Kalan. Oberlin College.
Further research is required to establish the effects of substance abuse by young people on the quality of family life cheap 110 mg sinemet overnight delivery, pressures on family finances buy sinemet 300 mg low cost, family stress levels buy sinemet 300 mg low price, family or friend disruptions buy discount sinemet 110mg online, emotional and psychological impacts on families, divorces, theft from family and friends, etc 24 Section 6 Approaches to combating drug use among Youth The above review of literature shows that youth substance abuse is a multidimensional challenge that requires a multifaceted and integrated gamut of interventions. Bronfenbrenner’s socio-ecological framework becomes handy when analysing interventions as it allows the targeting of interventions to all risk factors at all levels: be it individual, micro, mesosystem and exosystem. Thwala (2005) has noted that for any intervention to be successful, it should be underpinned by the following set of principles: Principle 1: Interventions should promote protective factors and seek to lessen risk factors. Individual Measures At the individual level, literature proposes many strategies for dealing with substance abuse. According to Brook, (2012) effective strategies at this level target the youth directly and also take into account peer influence. Brook observes “that combating substance use should involve reversing positive attitudes to drugs and dealing with personality dispositions that predispose them to drug use, and addressing symptoms of mental health problems that may cause and/or exacerbate the abuse of substances…. Young people should be trained on how to resist peer pressure as this is the single most important risk factor for the youth. Harker, at al (2008) also suggests that it is 25 important to have prevention programmes that attempt to engage the minds of the youth to avoid boredom. Such activities include life skills programmes, vocational training services, youth sport and recreational activities. Thwala (2005), highlights the following key elements for successful prevention programmes: Balancing negative and positive effects of substance abuse Improve social skills, Provide healthy alternatives to drugs, Focusing on harm reduction to those already affected, Emphasise quality of life changes Have interactive programmes and include peers and parents. As young people spend most their time at school, school-based programmes are essential. At school Harker, Myers and Parry (2008) caution against once-off training sessions by specialists as these may have perverse outcomes. They note that once off lectures have proved to be ineffective and instead stimulate more interests on substance abuse. Scare tactics, where inducing fear among substance abusers and immediate families by exaggerating the risks and relative dangers of illegal drugs, or misusing statistics to drive scare messages home, should also be avoided as they have rarely influenced behaviours in a positive way (United Nations Office on Drugs and Crime for Southern Africa 2004). When adolescents discover that they have been misled they subsequently reject any information on drugs from official channels Microsystem: Literature is clear that successful interventions are those that target the youth concurrently with their peers, parents and families. Improving parenting skills and behaviours is essential when trying to address a youth’s immediate toxic environment. The training for parents should ideally focus on The importance of nurturing one’s children. This could be done through regulatory interventions; decreasing access to alcohol via increased taxes; brief interventions for high risk drinkers; regulation of unlicensed outlets, and removing outlets from residential areas; advertisement restrictions; community mobilisation; and product related strategies such as appropriate labelling. A study by Griffin and Botvin, (2011) has documented various evidence based successful approaches to dealing with youth drug abuse problems. The study reviews tried and tested approaches that include school based, family-based and community-based prevention approaches Many policies address an individual, but miss the point that many individuals exist in a family context. Literature has shown that policies that seek to strengthen families are essential in addressing the substance abuse problem. In South Africa, one single most important initiative that seeks to address a family unit as key to building an individual is the 26 Green Paper on Families. It deals with how to promote family life, and how to strengthen families and what family strengthening programmes can be pursued. Societal/Community level and Drug use campaigns At the level of society or community, interventions should ideally focus on reducing youth’s access to drugs, and modifying societal norms that promote indulgence in these substances. Regulations and stricter enforcement of laws play a key role in reducing drug abuse. Harker, at al (2008) also recommends: Community mobilization to counter the sale of legal and illegal drugs. In 2003 the Department of Social development launched the campaign “Ke moja, I’m fine without drugs”.
Much variability is noted in the response data because the studies differ in methodology generic 110mg sinemet, individuals differ from each other buy sinemet 125mg cheap, and an individual’s response differs from day to day generic sinemet 110mg with mastercard. Table 10-12 buy 300 mg sinemet otc, a summary of the nitrogen requirement for all the data points included in the analysis by Rand and coworkers (2003), shows a nitrogen requirement of 105 mg/kg/d or 0. When only the indi- vidual data points in the primary estimation studies are considered, the nitrogen requirement is 102 mg/kg/d (0. As shown in Table 10-13, expected climate in the country of the study had a significant effect (p < 0. The effect of age, as shown in Table 10-13, was a nonsignificant difference of 27 mg N/d (0. Although the young individuals had a lower nitrogen require- ment than the older individuals, the requirement of young individuals was more variable and more positively skewed than that for the older individuals. Ninety-five percent confidence intervals for these estimates are 104 and 114 mg N/kg/d (0. Finally, the source of protein (90 percent animal, 90 percent vegetable, or mixed) did not significantly affect the median nitrogen requirement, slope, or intercept. It should be noted that almost all of the studies included as 90 percent vegetable were based on complementary proteins. For further discussion on this aspect of the data analysis and for information on vegetarian diets see later sections on “Protein Quality” and on “Vegetarians. Other Approaches to Determine the Protein Requirement Based on the Recent Meta-Analysis In addition to the linear statistical approach to determine protein requirements described in detail above, the authors considered three other statistical approaches to the nitrogen balance analysis (Rand et al. All data from the studies in the meta-analysis were fitted to the following models: linear, quadratic, asymptotic exponential growth and linear biphase (see Table 10-12). Since the above analyses used all of the available data points without linking the individuals or restricting the range of intakes, the authors made the decision to use nitrogen equilibrium as the criterion and individual linear regressions, using only those individuals in the primary data set to determine the protein requirement (Rand et al. However, due to the shortcomings of the nitrogen balance method noted earlier, it is rec- ommended that the use of nitrogen balance should no longer be regarded as the “gold standard” for the assessment of the adequacy of protein intake and that alternative means should be sought. Although the data indicate that women have a lower nitrogen require- ment than men per kilogram of body weight, this was only statistically significant when all studies were included, but not when the analysis was restricted to the primary data sets. This difference may be due to differ- ences in body composition between men and women, with women and men having on average 28 and 15 percent fat mass, respectively. When controlled for lean body mass, no gender differences in the protein re- quirements were found. For example, the intake that is estimated to be adequate for 80 per- cent of a healthy population is exp [0. Because the distribution of individual requirements for protein is log normal, and thus skewed, the calculated standard deviation and coeffi- cient of variation of requirement itself does not have the usual intuitive meaning (that the mean plus two standard deviations exceeds all but about 2. However, because this skew- ing is not extreme, an approximate standard deviation can be calculated as half the distance from the 16th to the 84th percentile of the protein requirement distribution as estimated from the log normal distribution of requirements. These have been analyzed and evaluated in various publications (Campbell and Evans, 1996; Campbell et al. The variability among the derived values, and the changes due to reassessment, are the result of the many inadequacies in the origi- nal data, which are described below. Only the study of Cheng and coworkers (1978) involved a direct com- parison of old with young adults; however, the authors made no assess- ment of the miscellaneous nitrogen losses and were not able to show any clear difference in the requirement of older and younger adults. Dietary energy excess is believed to give rise to erroneously low esti- mates of protein requirements (Garza et al. However, the energy requirements of the elderly have been shown to be higher than previously believed (Roberts, 1996). Moreover, the urinary creatinine to body weight ratio reported by Cheng and coworkers (1978) was the same in the old (0. This is in contrast to studies in the United States where lower creatinine to body weight ratios were observed in the older adults (0. The study of nitrogen balance by Zanni and coworkers (1979) sug- gested that the average amount of protein intake required to maintain nitrogen balance in older adults was very low (0.
The platelet count can decline by as much as 35 percent discount 300mg sinemet; however cheap sinemet 125 mg free shipping, the count does not usually fall below the lower limit of normal (Goodnight et al cheap 110mg sinemet otc. Although prolonged bleeding times have been shown to be beneficial in preventing heart disease purchase sinemet 125mg overnight delivery, bleed- ing times can become prolonged enough to result in excessive bleeding and bruising. Intervention studies that have examined the effects of n-3 fatty acids on bleeding time are mixed. None of the above studies reported excessive bleeding times, bleeding episodes, or bruising. Excessive cutaneous bleed- ing time and reduced in vitro platelet aggregability have been reported in Greenland Eskimos (Dyerberg and Bang, 1979; Dyerberg et al. A tendency to bleed from the nose and urinary tract was observed among the Greenland Eskimos (Bang and Dyerberg, 1980). Furthermore, ecologi- cal studies have suggested an increased risk of hemorrhagic stroke among Greenland Eskimos (Kristensen, 1983; Kromann and Green, 1980). A recent prospective study in the United States showed no association between intake of n-3 fatty acids and risk of hemorrhagic stroke (Iso et al. The median intake levels for the quintiles of n-3 polyunsaturated fat intake, however, ranged from only 0. The oxidative damage was shown to be reduced or prevented with the coconsumption of vitamin E (Ando et al. Studies on immune function were done in vitro and it is difficult, if not impossible, to know how well these artificial condi- tions simulate human immune cell response in vivo. Special Considerations A few special populations have been reported to exhibit adverse effects from consuming n-3 polyunsaturated fatty acids. Despite the favorable effects of n-3 fatty acids on glucose homeostasis, caution has been sug- gested for the use of n-3 fatty acids in those individuals who already exhibit glucose intolerance or diabetic conditions (Glauber et al. Increased episodes of nose bleeds have been observed in individuals with familial hypercholes- terolemia during fish-oil supplementation (Clarke et al. Anticoagu- lants, such as aspirin, warfarin, and coumadin, will prolong bleeding times and the simultaneous ingestion of n-3 fatty acids by individuals may exces- sively prolong bleeding times (Thorngren and Gustafson, 1981). During the early 1980s studies showed a hypercholesterolemic effect of trans fatty acids in rabbits (Kritchevsky, 1982; Ruttenberg et al. Renewed interest in the topic of hydrogenated fat in human diets, or more precisely trans fatty acid intake, started in the early 1990s. The availability of a methodology to distinguish the responses of individual lipoprotein classes to dietary modification expanded the depth to which the topic could be readdressed. Lipoprotein(a) (Lp(a)) concentrations in plasma have been associated with increased risk for developing cardiovascular and cerebrovascular disease, possibly via inhibition of plasminogen activity (Lippi and Guidi, 1999; Nielsen, 1999; Wild et al. Lp(a) concentrations have been reported by some investigators to be increased after the consumption of diets enriched in hydrogenated fat/trans fatty acids (Tables 8-9, 8-10, and 8-11) (Almendingen et al. The magnitude of the mean increases in Lp(a) concentrations reported to date that is associated with trans fatty acid intake for the most part would not be predicted to have a physiologically significant effect on cardiovascular disease risk. How- ever, an unresolved issue at this time is the potential effect of relatively high levels of trans fatty acids in individuals with initially high concentra- tions of Lp(a). The effect of trans fatty acids on hemostatic factors has been assessed by a number of investigators (Almendingen et al. In general, these researchers have concluded that hydrogenated fat/trans fatty acids had little effect on a variety of hemostatic variables. Similarly, Müller and colleagues (1998) reported that hemostatic variables were unaffected by the substitution of a vegetable oil- based margarine relatively high in saturated fatty acids when compared with a hydrogenated fish oil-based margarine. A few reports addressed the issue of trans fatty acid intake and blood pressure (Mensink et al. The authors concluded that consumption of diets high in saturated, mono- unsaturated, or trans fatty acids resulted in similar diastolic and systolic blood pressures. Because trans fatty acids are unavoidable in ordinary, nonvegan diets, consuming 0 percent of energy would require significant changes in patterns of dietary intake. It is possible to consume a diet low in trans fatty acids by following the dietary guidance provided in Chapter 11.