By J. Baldar. Finch University of Health Sciences/The Chicago Medical School. 2019.
Aside from the passing reference to ‘‘phlegmatic’’ thin women in ¶ order malegra dxt plus cheap erectile dysfunction gnc products, a hu- moral causation is ascribed to only one condition buy malegra dxt plus line erectile dysfunction age at onset, dysentery (¶) buy malegra dxt plus overnight delivery erectile dysfunction on prozac. Here, dysentery is diﬀerentiated into that caused by phlegm and that caused by bile; the therapies diﬀer accordingly. In deﬁning ‘‘the diseases of women,’’ Treatments for Women includes most of the same categories as had Conditions of Women: menstrual irregularities, uterine prolapse, problems of fertility, diﬃculty of birth. Some are matters of nuance; others are more substantivelydis- tinctive conceptions of what kinds of problems women really have. Of princi- pal concern to the authorof Treatments forWomen is the promotion of women’s fertility. We see this emphasis already in the opening lines, quoted above, on the necessityof distinguishing hot women from cold. Heat and cold are of con- cern because they are impediments to conception; as stated explicitly in ¶, by use of the prescribed suﬀumigation women ‘‘will be found cleansed of this awful excess [of cold] and [will be made] ready for conception. Here we see more of Conditions of Women’s notion of menstrua- tion as ‘‘woman’s ﬂower’’—that is, the necessary prelude to conception—than the view that it is a purgation vital in and of itself for women’s health. Given this continual emphasis on promoting fertility, it is perhaps not surprising that Treatments for Women nowhere mentions contraceptives. A chapter devoted to the eﬀects of sexual abstinence (¶) says that continent women—vowed women, nuns, and widows—will incur ‘‘grave suﬀering’’ if they are not able to sate their desire. Unlike Condi- tions of Women and every other Salernitan textbook of the period, however— where uterine suﬀocation is a regular feature of the canon of gynecological dis- eases—Treatments forWomen employs the term ‘‘uterine suﬀocation’’ just once, and this only in passing in a completely diﬀerent context. The latter is an al- most aphoristic statement: ‘‘Certain girls seem as if they are suﬀering from the falling sickness, which comes about from uterine suﬀocation compressing the respiratory organs’’ (¶). The passage just quoted immediately follows an assertion that the breast pain that some young women experience occurs upon eruption of the menses (i. This might suggest an association of suﬀocation with menstruation, yet none of the three chapters devoted to menstrual retention (¶¶, , and –) mentions suﬀocation. Likewise, the metaphorical description of the womb in another chapter (¶, on postnatal uterine pain and displacement) asbeing‘‘asifitwerewild. This view of sexuality is, after all, implicit in ¶ when it identiﬁes abstinence as a possible prelude to disease. Yet there is equal acknowl- edgment that heterosexual activity might be painful in and of itself, or that it can lead to other disorders. According to ¶, prolapse of the uterus can be caused by the excessive size or length of the penis; ¶ suggests that the vagina can swell up because of coitus. In ¶, one of many remedies for pain in the womb, it is suggested that sexual activity is capable of desiccating the womb and heating it to an inordinate degree. One chapter (¶) speciﬁcally implicates retained semen as the culprit in a certain disorder: a piece of ﬂesh hanging from the womb. This occurs not from the woman’s own seed being retained due to lack of intercourse but rather ‘‘because women do not clean themselves after coitus,’’ thereby allowing the semen (whose is unspeciﬁed) to be retained and trapped within the uterus. In ¶, the author of Treatments for Women ac- knowledges the cause of the discomforts of sexual abstinence not as retained or corrupted semen but as physical and perhaps even emotional desire itself: ‘‘Such women,when they have immoderate desire to have intercourse and they do not do so, if they do not satiate the desire they incur grave suﬀering. The therapy advocated by Treatments for Women is tra- ditional in that it employs ‘‘sweet-smelling’’ substances to be applied to the vagina (laurel or musk oil, or the compound medicine trifera magna—made of opium, cinnamon, cloves, etc. The intended eﬀect, however, is neither to lure the uterus back into place nor to expel the collected and corrupted menses or seed; rather, the text says unambiguously that ‘‘this constrains the lust and sedates the pain. With its concern about chastity, ¶ may, in fact, have more to do with social ‘‘realities’’ than medical theory. When s/he spoke of ‘‘some widows who Introduction are not permitted to take a second vow,’’150 the author of Treatments forWomen may have been referring to the fact that, in Salerno in this period, widows living under traditional Lombard law would have been under special pressure, more so than women living under Roman law, to keep their late husband’s bed ‘‘chaste. Given that remarriage would have threatened a woman with loss of her property and perhaps guardianship of her children as well, maintenance of chastity may well have been a pressing concern. Five recipes are given as a group (¶¶– and –),153 with a sixth comment on the subject later (¶). The main group of remedies opens with a straightforward and non- apologetic statement: ‘‘A constrictive for the vagina, so that women may be found to be as though they were virgins, is made in this manner. The third recipe (¶) shows that not every kind of deception was ap- proved: ‘‘There are some ﬁlthy and corrupt prostitutes who desire to be found more than virgins. They make a certain constrictive for this, but they are ill advised for they render themselves bloody and they wound the male member. They take glass and natron and reduce them to a powder and place them in the vagina. The desire of women, ‘‘honest’’ or ‘‘dishonest,’’ to ‘‘restore’’ their virginity suggests acknowledgment by at least some medical practitioners that women’s honor in this Mediterra- nean culture, to a degree that would never have been true for men, was bound up intimately with their sexual purity. If successful, these recipes may well have made the diﬀerence for some women between marriage and ﬁnancial security, on the one hand, and social ostracization and poverty, on the other. From recognition of diﬃculties of bladder control (a common aﬄiction of older women, exacerbated by frequent childbearing, ¶) to cracked lips caused by too much kissing (¶) to breast pain during lactation (¶) to instructions for cutting the umbilical cord (¶), we sense the mundane but nonetheless pressing concerns of women. Care of obstetrical problems, especially those consequent to birth, is a particularly frequent concern (¶¶, –, , and –). Here, the only recommendations are to bathe, fumigate, and oﬀer sternutatives (substances that induce sneezing) to women giving birth (¶) and to give a potion and fumigate with vinegar to aid birth and help expel the afterbirth (¶). This absence is perhaps to be explained by the au- thor’s belief that childbirth in and of itself is not pathological. It does not, in other words, demand the attention of a medical practitioner; what needs to be known about aiding labor is already part of the common knowledge of the women (relatives and neighbors) who would normally attend the birth. In ¶, for instance, we ﬁnd ‘‘a very useful unguent for sunburn and any kind of lesions, but espe- cially those caused by the wind, and for the blemishes on the face which Saler- nitan women make [while mourning] for the dead. Having realized that her husband had reached the end of his life, she delivered an impassioned speech of grief, all the while ‘‘ripping her cheeks with her nails and tearing at her disheveled hair. To the extent that these are mostly uro- genital and otherconditions of the pelvic region that men sharewith women— infertility caused by obesity or emaciation (¶¶–), hemorrhoids (¶),167 kidney and bladder stones (¶¶–), and intestinal pain (¶)—their pres- ence is understandable. Yet the author not merely mentions that men have these same disorders but (with the exception of two cases, where the ther- apy is not diﬀerentiated) s/he provides full details of the diﬀering treatments needed for men. Moreover, there are two remedies exclusively for men: ¶ on swelling of the penis and lesions of the prepuce and ¶ on swollen tes- ticles. The inclusion of this material probably reﬂects more than the mere cate- gorical aﬃnity of gynecological and andrological diseases. In his mid-twelfth- century compendium of medical practices, the Salernitan physician Johannes Platearius credited ‘‘Salernitan women’’ with a remedy for pustules of the penis very similar to that described in ¶. I will have more to say about the Salerni- tan women momentarily; here it should simply be noted that Platearius’s cita- tion suggests that it was not considered problematic for female practitioners to treat both men’s and women’s reproductive complaints. Copho is credited with the statement that sneezing can aid obstructed birth by rupturing the ‘‘cotyledons’’ (¶). He is also mentioned as the ‘‘author’’ of a special powder used for treatment of impetigo (a skin condition). Both place greatest stress on maintaining (or attempting to maintain) regular menstruation;171 both are concerned to remedy displacements and lesions of the uterus; both oﬀer sug- gestions for aiding diﬃcult childbirth.
In a bid to frame the interrelationships and intra-relationships of the multiple influences on drug and alcohol abuse behaviour buy 160 mg malegra dxt plus visa erectile dysfunction and diabetes ppt, as well as how they operate at different levels discount 160 mg malegra dxt plus with amex erectile dysfunction doctor in delhi, researchers and practitioners have identified two frameworks malegra dxt plus 160mg sale new erectile dysfunction drugs 2013; the supply and demand framework and the Bronfenbrenner’s socio-ecological model (Bronfenbrenner, 1993). The Supply and Demand framework has three intervention windows: Demand side, Supply side and Harm Reduction (see Figure 11). On the demand side substance abuse is tackled through poverty reduction strategies, advocacy, education and communication, fostering socio-economic development and advancing anti-substance abuse social policies. On the supply side the key intervention areas include controlling production, sale, marketing and distribution of harmful substances. It also includes law enforcement and where necessary taking legal action against supplies of illegal substances. Harm reduction is based on treatment, aftercare and reintegration of those dependent on substances. The South African Drug prevention Master Plan employs the supply and demand framework. Figure 11: Supply and Demand Framework Demand Reduction Supply Reduction Harm Reduction Poverty Reduction Controlling the production, manufacture, sale, distribution and trafficking of drugsprecursor Treatment materials and manufacturing facilities, Advocacy Controlling the distribution of and access to raw drugs and precursor materials Aftercare Education and Communication Seizing and destroying precursor materials, raw materials and products, refineddrugs, production, manufacturing and distribution facilities, and resources; Development Re-integration of substance dependents with society. Taking legal action on the use, abuse, production, Social Policy Application manufacture, marketing, distribution and trafficking of precursor materials, raw materials and products, refined drugs, manufacturing and distribution and facilities, and resources. The main drawback of the Supply and Demand framework is that it places intervention programmes in silos, with limited vertical and horizontal interactions. In reality, substance abuse is multifaceted challenge that requires a multidimensional and integrated set of intervention strategies. Figure 12 provides a pictorial view of the Bronfenbrenner socio-ecological framework. The framework implies that a substance abuser is affected by different types of environmental systems. The nested structures of these environmental systems begin with the individual domain, moving outwards to the microsystem, the mesosystem and finally, the exosystem. Applications of this framework can be found in Mason, Cheung, & Walker, (2004) for substance use; Yu, Stiffman, & Freedenthal, (2005) on tobacco use; and Marsden, Boys, 16 Farrell, Stillwell, Hutchings, et al. The ecological model takes a holistic view to the problem and demonstrates that factors driving drug abuse are interrelated and intervention strategies or programmes for combating the scourge should be integrated. The next paragraphs review literature on the determinants of substance abuse following the Bronfenbrenner’s socio-ecological model. Steinman and Zimmerman (2004) observe that behaviours such as low religious involvement, short-term goals in life, depressive symptoms and a poor sense of wellbeing and low self-esteem make the youth succumb to substance abuse. Evidence also points to the fact that youth are also prone to drug abuse because of their vulnerability (Mohasoa, 2010). Youth become vulnerable because they are in a phase of substantial experimentation, they are unemployed, have no income, and are poor, among other things (Kadalie & Thomas, 2013; Parry et al. Interviews with respondents, Rocha-Silva reported that youths use drugs 17 to gain confidence in dealing with people and stressful situations surrounding them. Mohasoa (2010) also reports that youth use substances because they are overwhelmed by the challenges in their own lives or families, and society at large. For example, stressors in their own lives could be cold weather which may lead them to taking solvents in order to escape the misery associated with the stressful environment. Microsystem The microsystem envelopes the individual domain and represents one’s immediate environment. It focusses, inter alia, on the household and family influences, neighbourhood, school, and peer pressures. Many studies have singled out the family as the most significant determinant of substance abuse by the youth at the microsystem level. In a study of learners in the Western Cape, Peltzer and Ramlagan (2009) found a strong link between risky drinking behaviours and lack of parental and peer support, school truancy, and mental distress. Pretorius (2003), observe that exposure to alcohol in the family causes risk behaviours such as rebelliousness and having friends who drink (Pretorius 2010). In addition, literature shows that youths that have parents who drink heavily, and/or are tolerant of alcohol use, as well as having close acquaintances who drink, places youth at risk for heavy drinking. Youths tend to imitate the behaviours of their parents, guardians or other influential people and quantitative and qualitative evidence suggests that those with adequate role models are less likely to indulge in substance abuse (Morojele et al. Conversely, youth with inadequate role models (role models who drink or do drugs) consider it acceptable (Brook et al 2006 and Onya, 2005). On the other hand, a nurturing home environment, encompassing family supervision and monitoring, together with open communication lines between parents and children, has been empirically determined to be strongly associated with low substance abuse (Meghdadpour et al. Meghdadpour et al found that in South Africa, family supervision is likely to reduce male youths being drunk by 23% and lowers their chance of using illegal drugs by 38%. Therefore to combat drug and alcohol abuse emphasis should be placed on strategies that address “parental drinking, low parental monitoring, low parental bonding, poor parent-child communication, poor school performance, low school commitment, peer norms, peer drinking, peer influence, peer delinquency” South African empirical studies indicate that peer pressure is one of the most significant and most consistent predictor of substance use among youth (Brook et al. Peers encourage their uninitiated peers to use drugs, and more often drug or alcohol use is celebrated with those taking illegal substance held in high regard. Youth will then want to be accepted by their peers in these substance abuse networks at all costs. According to Bility (1999) peer pressure is rampant in youth gang networks and other marginalised groups such as street children. Evidence also indicates that youth prefer to discuss issues with their peers more than they would with their family members, teachers, or medical doctors (Hoberg, 2003). They value opinions or support of their peers more than any other social structures at their disposal (Hoberg, 2003). The pressure to be recognised and accepted by peers and gain meaningful participation inadvertedly increases vulnerability of the youth (Ungar, 2006:7 18 It is important to note that peer pressure and inadequate parental role modelling discussed above reinforce each other. When there are no good parental role models for the youth, peers become role models and the outcomes may not be desirable. Another area that has been variously cited as key to drug/alcohol abuse prevention in the microsystem is the school. The schools is part of the immediate environment of the learner or youth and quantitative and qualitative evidence shows that some of the influences of alcohol and drug abuse are found within the school environment. This study noted that when alcohol is close to the school it can easily be brought into the school. The school also lends itself to being a space for illegal substance when some learners are demotivated, have low academic aspirations or their performance is below par. Flisherv at al, (2003) have found a direct relationship between drug abuse with learners’ poor performance, absenteeism and repetition of a grade. Mesosystem The mesosystem is simple a system of microsystems and how they interact. It involves linkages between an individual and family, family and school, peer group and family, or between family and church. The primary risk factor is when microsystems are not interacting well leaving children exposed to pressures that will see them succumb to substance use. A good example is that if the family does not interact with peers of their children, such children will be exposed to peer pressure.
If prescribing Throughout history purchase 160mg malegra dxt plus with amex impotence beta blockers, humanity has that instead of deﬁning an arbitrary activities and industry proﬁts were kept such fears at bay by accepting threshold of abnormality buy generic malegra dxt plus on line erectile dysfunction statistics australia, governments not affected by this support 160 mg malegra dxt plus amex erectile dysfunction massage, it would burdens and sacriﬁces in the present not be offered. Now, for those without Competing Interests: The author has declared that to be completely independent of other religious belief, death has become no competing interests exist. Politicians genuinely more ﬁnal, and salvation must be interested in the welfare of patients and Citation: Heath I (2006) Combating disease sought before death in an ever- mongering: Daunting but nonetheless essential. This is an open-access demand more explicit acknowledgment article distributed under the terms of the Creative inﬂuence, an ability to acknowledge, Commons Attribution License, which permits of the limits of medical knowledge, accommodate, and move beyond these unrestricted use, distribution, and reproduction in less extrapolation beyond research any medium, provided the original author and source ﬁndings, and much more responsible are credited. These predicted disadvantages where individualised solutions become have become more and more apparent, prevalent, societal, population-based so there has been a systematic attempt interventions tend to fall away, and the to improve motivation through the result is worsening health inequalities. Percentage of Doctors That Use you don’t take more exercise, improve limits to medical intervention. There Information Provided by Drug Company your diet or take this medication, is a clear and urgent need for more Representatives in Their Clinical Practice you actively put yourself at risk of an research into the psychological impact Data derived from . Male preventive technologies for currently The second approach is to interpose pattern baldness and shyness, to take healthy populations, and set the some new, supposedly protective just two examples, are not diseases thresholds for intervention accordingly. The current use of diagnostic drift in a whole range of population most at risk of ischaemic pharmaceuticals for public health conditions, from depression  to heart disease, and could then calculate policy falls into this category. As more hypertension , with pressure for the thresholds of blood pressure and and more risk factors are identiﬁed, more and more people to be included cholesterol, which would identify this closely followed by a pharmaceutical within the range of abnormal and most vulnerable 10% of the population. The justiﬁcation Clearly, these thresholds would be shift the whole bell curve legitimises for these treatments is often based much higher than those recommended the wholesale drug treatment of on short-term studies, which are today. There is insufﬁcient Preventing Disease through There is a clear need to reiterate Rose’s recognition of the fact that the less Population-Based Measures distinction and prioritise the reduction the need for treatment, the higher The seeds of the current situation of exposure to biological hazards above the number needed to treat for given were already present 21 years ago, the application of pharmaceutical outcomes and the higher the risk when Geoffrey Rose wrote his seminal prophylaxis. In this paper, exponential spending on preventive he showed that risk factors for health pharmaceuticals, justiﬁed by potential The Challenge to Politicians are almost always distributed across a long-term beneﬁts to an unidentiﬁable, Politicians are charged with overseeing bell curve and argued that more could but statistically signiﬁcant, number the organisation of society for the be achieved by attempting to shift of people in the population. A major political the whole of the bell curve than by doctors treat patients with diseases, achievement of Western societies, targeting those at highest risk (Figure progress can be assessed and the with the very notable exception 2). This means of the United States, has been the number of people at low risk may give that if the patient responds to provision of universal health-care rise to more cases of disease than the treatment, it can be continued; if systems available and accessible to small number who are at high risk. There is now a pressing need There has been general acceptance of When doctors treat people who are for politicians to recognise the this argument, but Rose’s own warnings merely at risk of disease, the outcome threat to these systems, and to the seem to have been lost. Authentic health care companies bring—against the for the old and frail has much more increasing capacity of this industry to to do with helping to preserve their bankrupt universal health-care systems. The costs of alongside doctors and many others, to health care are highest during the year make such care available, and this in before death, regardless of the age at itself will be an important part of the which death occurs. The aim economic importance of treatment of preventive health care should be technologies, particularly for those the reduction of untimely deaths in illnesses that primarily affect poorer relatively young people, but the fear people in poorer countries . This of accusations of ageism in health care has meant a shift of attention from means that doctors are encouraged the sick to the well and from the poor to go on prescribing preventive to the rich . This effect of global pharmaceuticals to people well into markets requires a response in the their late eighties and nineties . Health inequalities matter predicated on social solidarity, the Always Distributed across a Bell Curve globally as well as locally. A way forward rights of individuals to treatment have Geoffrey Rose argued that more could be might be through taxation or other to be balanced against the duties of achieved by attempting to shift the whole of means, to make the sale of preventive citizens to provide the appropriate the bell curve (the “population approach” to prevention) than by targeting those at highest technologies in countries with above- level of funding. Human societies are riven by the effects beneﬁts in terms of reducing suffering Population-based interventions favour of greed and fear. Publicly funded the poor because such interventions health technologies has opened up preventive treatment of risk factors are applied universally and the poor a new arena of human greed, which for those who have already exceeded are the most at-risk; individually responds to an enduring fear. The the average life expectancy seems based interventions favour the rich greed is for ever-greater longevity; the particularly hard to justify. For this reason, tragedy is that the greed inﬂates the been described as a “fundamental population approaches to tackling the fear and poisons the present in the cause” of disease, which works fundamental causes of socioeconomic name of a better, or at least a longer, through a multiplicity of risk factors deprivation must remain the most future. Ultimately, the only way of and pathophysiological pathways effective way of tackling health combating disease mongering is to to produce multiple disease states inequalities . Even if one of these pathways a continuing role for individually based the timing of our dying. Barnard D (1988) Love and death: Existential dimensions of physicians’ difﬁculties with disease will reappear in a different not to be exacerbated. Abbasi K, Smith R (2003) No more free intervention is situated, the less likely disease, less remediable than poverty lunches. J, Koskela K (1982) Theory and action for guidelines on cardiovascular disease prevention 12. Freemantle N, Hill S (2002) Medicalisation, best strategy for reducing deaths from heart 14. Schwartz☯ so normal experiences get labeled The Case of Restless Legs as pathologic, and by expanding the Syndrome deﬁnition of disease to include earlier, To get a sense of how the media works milder, and presymptomatic forms in the context of a major disease (e. Discussions about disease In 2003, GlaxoSmithKline launched a mongering usually focus on the role of campaign to promote awareness about pharmaceutical companies—how they restless legs syndrome, beginning with “[Restless legs syndrome] is quite a serious sleep promote disease and their products press releases about presentations at disorder that affects a lot of people Their sleep is through “disease awareness” campaigns the American Academy of Neurology disturbed and, unless they are really awake, they and direct-to-consumer drug will not be aware of it” . Sometimes you previously approved for Parkinson promoted in another way: through feel sad or distracted or anxious. Does it mean you release entitled “New survey reveals approach stories about new diseases need medication? For some people, disorder—restless legs syndrome—is mongering by the pharmaceutical symptoms are severe enough to be keeping Americans awake at night” industry, pharmaceutical consultants, disabling. But for many others with and advocacy groups, journalists, too, milder problems, these “symptoms” may end up selling sickness. The side effects that overwhelm any • An urge to move the legs due to an authors have declared that no competing interests exist. Typically, the disease is vague, • Symptoms that occur primarily at night public domain, this work may be freely reproduced, with nonspeciﬁc symptoms spanning distributed, transmitted, modiﬁed, built upon, or a broad spectrum of severity—from and that can interfere with sleep or otherwise used by anyone for any lawful purpose. Schwartz are at the Veterans Affairs Outcomes Group, White River treatment gets enlarged in two ways: can range from less than once a month Junction, Vermont, United States of America, and the by narrowing the deﬁnition of health to many times a day. Recommended Center for the Evaluative Clinical Sciences, Dartmouth treatments include stretching exercises Medical School, Hanover, New Hampshire, United States of America. Key Elements of Disease Mongering and How the Media Could Do Better Key Elements of Disease Mongering When the Media Can Get Co-opted Suggestions for Doing Better Exaggerate the prevalence of disease Create a broad disease deﬁnition based on Uncritically accepts disease deﬁnition. Learn exact deﬁnition of disease and question whether it is appropriately vague and prevalent symptoms. Determine whether the prevalence estimate is credible: Are the “gold standard” diagnostic criteria being used as designed? Blur the distinction between mild and severe Highlights the important physical, social, and Be clear about the spectrum of disease.