Annual Review of Medicine - Volume 36, 1985

This chapter outlines requirements for quitting smoking successfully, and for effective treatments. It presents practical guidelines for physicians and allied health care providers with specific recommendations for how to motivate and help patients quit “on their own” and how to select more intensive backup treatment if needed. Useful guides, references, and resources are suggested, with recommendations concerning optimal use of nicotine chewing gum.

Exposure of the fetus at any gestational stage to high concentrations of alcohol can adversely affect growth, morphology, and neurophysiologic development. Sustained heavy drinking can result in the fetal alcohol syndrome. Cessation of heavy drinking during pregnancy will benefit both mother and child. Primary health care providers can effectively identify and treat women at risk.

The circadian pacemakers, which time the approximately 24-hour rhythms in sleep and wakefulness, neuroendocrine, thermoregulatory, and other body functions, resynchronize only slowly after an abrupt phase shift in environmental time cues. While the symptoms of jet-lag are transient, the kinds of repeated shifts over a number of years experienced by shift-workers on rotating schedules induce sleep-wake disorders, gastrointestinal pathology, and an increased risk of cardiovascular disease. There is significant interindividual variation in the ability to adapt and also a deterioration with age. Evidence is accumulating that poor adapters present with a Shift Maladaption Syndrome with characteristic pathological manifestations.

Carcinoma of the large bowel arises almost exclusively in neoplastic polyps, which are present in 5-10% of the population over age 40. These polyps may be of three histologic types: (a) tubular adenoma (adenomatous polyp), (b) tubulovillous adenoma (villoglandular polyp), and (c) villous adenoma. The tendency for malignant change is greatest in the villous adenoma (41%) and in tubulovillous (villoglandular polyps–23%). In tubular adenomas (simple adenomatous polyps), the incidence of malignancy is 5% over all. The tendency toward malignant change is determined by histologic type, size, and degree of atypicality of adenoma. Early detection and complete removal of neoplastic polyps of the colon are essential to the prevention of cancer of the large bowel, and this may usually be done in most cases with the colonoscope.