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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Nicotine dependence develops over time as a person continues to smoke. The risk for the development of dependence and how long it takes to become dependent differs from person to person; there is not a clear consensus on how long it takes for dependence to develop.
Nicotine dependence results in daily, heavy usage of cigarettes and produces withdrawal symptoms such as urges to smoke, negative moods, and difficulty concentrating, when the person stops smoking. These withdrawal symptoms are so unpleasant that smokers very frequently return to smoking. However, while it is known what nicotine dependence does—permits heavy smoking and causes severe withdrawal symptoms and relapse back to smoking—it is hard to measure nicotine dependence apart from these consequences.
Nicotine dependence has been classified as a chronic, relapsing disease. In other words, it is a long-term disorder that may have periods of relapse and remission that require repeated intervention, similar to other chronic conditions such as diabetes or hypertension. This perspective reinforces the idea that nicotine dependence is not a bad habit but an actual disease that requires ongoing treatment.
Nicotine dependence, or tobacco use disorder, is a state of dependence upon nicotine. There are different ways of measuring nicotine dependence. Some nicotine dependence assessments focus on key physical dependence outcomes like the development of tolerance which allows people to smoke heavily. Other assessments ask about psychosocial outcomes or underlying mechanisms of dependence. These different assessments either characterize dependence as a continuous construct or use cut-offs to diagnose whether or not a person is dependent.
Nicotine dependence is especially a concern among some populations such as those with co-occurring mental illness. There are evidence-based nicotine dependence treatments that include both medication and psychosocial interventions that can significantly increase a smoker’s chances of quitting successfully.
Nicotine withdrawal is the effect that nicotine-dependent individuals experience after they discontinue or decrease nicotine use. Nicotine is an addictive substance found most commonly in tobacco and tobacco products including cigarettes, cigars, chewing tobacco, pipe tobacco, snus, snuff, and most e-cigarette liquid. Withdrawal is the body’s reaction to not having the nicotine it had become accustomed to. Withdrawal is most common and intense in cigarette smokers and intermediate in smokeless users. The symptoms of nicotine withdrawal usually appear 2-3 hours after last intake of nicotine and peak in 2-3 days. In a minority of smokers, cravings may last for years. Nicotine withdrawal causes few physical signs and is not life-threatening but associated cravings can be as severe as withdrawal from other drugs. There is some evidence that stopping nicotine may make a prior psychiatric problem worse but this is uncertain. After the initial withdrawal period, anxiety, depression, and quality of life generally improve such that former smokers are better off than continuing smokers.
The most documented symptoms are cravings for nicotine, anger/irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain, and difficulty concentrating. Symptoms are usually strongest for the first few days and then dissipate over 2-4 weeks. Withdrawal symptoms make it harder to quit nicotine products and most methods for quitting smoking involve reducing nicotine withdrawal. The most common symptoms are irritability, anxiety and difficulty concentrating. Depression and insomnia are the least common. Other withdrawal symptoms may include constipation, cough, dizziness, drowsiness, headache, impulsivity, fatigue, flu symptoms, mood swings, mouth ulcers, and increased dreaming. Cessation of nicotine usually increases eating and weight, decreases memory, decreases the ability to pay attention and concentrate on tasks, and decreases heart rate. Cessation of tobacco can also require changes in levels of various medications.
A psychoactive drug, such as a stimulant, is a chemical or substance that effects one’s behavior, mind, and body. A stimulant can be smoked, injected, snorted, taken in pill form, chewed and even ingested in the form of a drink. Synthetic stimulants are becoming increasingly popular as users attempt to alter the chemicals in drugs to create different reactions, and ultimately steer clear of jail time, legal penalties and detection in drug screening efforts.
If a substance is used over a long period of time and the user becomes dependent upon it, a substance abuse issue begins to appear. Substance abuse may lead to substance dependence and with time, addiction. Both mental and physiological dependence requires the development of tolerance leading to withdrawal symptoms. Stimulants come in a very large variety of subtypes and among the most common are caffeine, nicotine, cocaine, methamphetamine, amphetamines, amphetamine congeners, electronic cigarettes, diet pills, plant stimulants, energy drinks, and the ever-evolving designer stimulants such as bath salts. Caffeine and nicotine are the most popular stimulants used today, with roughly 400 million cups of coffee consumed daily and 36.5 million current cigarette smokers, according to a 2015 study conducted by the Centers for Disease Control and Prevention. Nicotine, however, is treated separately psychiatrically under tobacco use disorder.
Stimulant use disorder is a type of substance use disorder that involves the abuse of stimulants. It is defined in the DSM-5 as "the continued use of amphetamine-type substances, cocaine, or other stimulants leading to clinically significant impairment or distress, from mild to severe." These psychoactive drugs, known as stimulants, are the most widely used drugs in the world today. Approximately 200 million Americans have used some type of a stimulant in the past year alone.
Examples (and ICD-10 code) include:
- F10.0 alcohol intoxication
- F11.0 opioid intoxication
- F12.0 cannabinoid intoxication
- F13.0 sedative and hypnotic intoxication (see benzodiazepine overdose and barbiturate overdose)
- F14.0 cocaine intoxication
- F15.0 caffeine intoxication
- F16.0 hallucinogen intoxication (See for example Lysergic acid diethylamide effects)
- F17.0 tobacco intoxication
The term contact high is sometimes used to describe intoxication without direct administration, either by second-hand smoke as with cannabis, or by placebo in the presence of others who are high.
Substance intoxication is a type of substance use disorder which is potentially maladaptive and impairing, but reversible, and associated with recent use.
If the symptoms are severe, the term "substance intoxication delirium" may be used.
Generic slang terms include: getting high or being stoned or blazed (all usually in reference to cannabis), with many more specific slang terms for each particular type of intoxicant. Alcohol intoxication is even graded in intensity, from buzzed, to tipsy, all the way up to hammered, smashed, wasted, destroyed, and a number of other similar terms.
Tobacco use has predominantly negative effects on human health and concern about health effects of tobacco has a long history. Research has focused primarily on cigarette tobacco smoking. In 1950, Richard Doll published research in the "British Medical Journal" showing a close link between smoking and lung cancer. Four years later, in 1954, the British Doctors Study, a study of some 40,000 doctors over 20 years, confirmed the suggestion, based on which the government issued advice that smoking and lung cancer rates were related.
Tobacco smoke contains more than fifty chemicals that cause cancer. Tobacco also contains nicotine, which is a highly addictive psychoactive drug. When tobacco is smoked, nicotine causes physical and psychological dependency. Cigarettes sold in underdeveloped countries tend to have higher tar content, and are less likely to be filtered, potentially increasing vulnerability to tobacco smoking related disease in these regions.
Tobacco use is the single greatest cause of preventable death globally. As many as half of people who use tobacco die from the results of this use. The World Health Organization (WHO) estimates that each year tobacco causes about 6 million deaths (about 10% of all deaths) with 600,000 of these occurring in non smokers due to second hand smoke. In the 20th century tobacco is estimated to have caused 100 million deaths. Similarly, the United States Centers for Disease Control and Prevention describes tobacco use as "the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide."
Tobacco use leads most commonly to diseases affecting the heart, liver and lungs. Smoking is a major risk factor for heart attacks, strokes, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis), and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancer). It also causes peripheral vascular disease and hypertension. The effects depend on the number of years that a person smokes and on how much the person smokes. Starting smoking earlier in life and smoking cigarettes higher in tar increases the risk of these diseases. Also, environmental tobacco smoke, or secondhand smoke, has been shown to cause adverse health effects in people of all ages. Tobacco use is a significant factor in miscarriages among pregnant smokers, and it contributes to a number of other health problems of the fetus such as premature birth, low birth weight, and increases by 1.4 to 3 times the chance of sudden infant death syndrome (SIDS). Incidence of erectile dysfunction is approximately 85 percent higher in male smokers compared to non-smokers.
Several countries have taken measures to control the consumption of tobacco with usage and sales restrictions as well as warning messages printed on packaging. Additionally, smoke-free laws that ban smoking in public places such as workplaces, theaters, and bars and restaurants reduce exposure to secondhand smoke and help some people who smoke to quit, without negative economic effects on restaurants or bars. Tobacco taxes that increase the price is also effective, especially in developing countries.
Nicotine poisoning describes the symptoms of the toxic effects of nicotine following ingestion, inhalation, or skin contact. Nicotine poisoning can potentially be deadly, though serious or fatal overdoses are rare. Historically, most cases of nicotine poisoning have been the result of use of nicotine as an insecticide. More recent cases of poisoning typically appear to be in the form of Green Tobacco Sickness, or due to unintended ingestion of tobacco or tobacco products or consumption of nicotine-containing plants.
The estimated lower limit of a lethal dose of nicotine has been reported as between 500 and 1000 mg. Children may become ill following ingestion of one cigarette; ingestion of more than this may cause a child to become severely ill. The nicotine in the e-liquid of an electronic cigarette can be hazardous to infants and children, through accidental ingestion or skin contact. In some cases children have become poisoned by topical medicinal creams which contain nicotine.
People who harvest or cultivate tobacco may experience Green Tobacco Sickness (GTS), a type of nicotine poisoning caused by skin contact with wet tobacco leaves. This occurs most commonly in young, inexperienced tobacco harvesters who do not consume tobacco.
Alcoholic beverages are classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen (carcinogenic to humans). IARC classifies alcoholic beverage consumption as a cause of female breast, colorectum, larynx, liver, esophagus, oral cavity, and pharynx cancers; and as a probable cause of pancreatic cancer.
3.6% of all cancer cases and 3.5% of cancer deaths worldwide are attributable to consumption of alcohol (also known formally as ethanol).
Nicotine poisoning tends to produce symptoms that follow a biphasic pattern. The initial symptoms are mainly due to stimulatory effects and include nausea and vomiting, excessive salivation, abdominal pain, pallor, sweating, hypertension, tachycardia, ataxia, tremor, headache, dizziness, muscle fasciculations, and seizures. After the initial stimulatory phase, a later period of depressor effects can occur and may include symptoms of hypotension and bradycardia, central nervous system depression, coma, muscular weakness and/or paralysis, with difficulty breathing or respiratory failure.
From September 1, 2010 to December 31, 2014, there were at least 21,106 traditional cigarette calls to US poison control centers. During the same period, the ten most frequent adverse effects to traditional cigarettes reported to US poison control centers were vomiting (80.0%), nausea (9.2%), drowsiness (7.8%), cough (7.2%), agitation (6.6%), pallor (3.0%), tachycardia (2.5%), diaphoresis (1.5%), dizziness (1.5%), and diarrhea (1.4%). 95% of traditional cigarette calls were related to children 5 years old or less. Most of the traditional cigarette calls were a minor effect.
Calls to US poison control centers related to e-cigarette exposures involved inhalations, eye exposures, skin exposures, and ingestion, in both adults and young children. Minor, moderate, and serious adverse effects involved adults and young children. Minor effects correlated with e-cigarette liquid poisoning were tachycardia, tremor, chest pain and hypertension. More serious effects were bradycardia, hypotension, nausea, respiratory paralysis, atrial fibrillation and dyspnea. The exact correlation is not fully known between these effects and e-cigarettes. 58% of e-cigarette calls to US poison control centers were related to children 5 years old or less. E-cigarette calls had a greater chance to report an adverse effect and a greater chance to report a moderate or major adverse effect than traditional cigarette calls. Most of the e-cigarette calls were a minor effect.
From September 1, 2010 to December 31, 2014, there were at least 5,970 e-cigarette calls to US poison control centers. During the same period, the ten most frequent adverse effects to e-cigarettes and e-liquid reported to US poison control centers were vomiting (40.4%), eye irritation or pain (20.3%), nausea (16.8%), red eye or conjunctivitis (10.5%), dizziness (7.5%), tachycardia (7.1%), drowsiness (7.1%), agitation (6.3%), headache (4.8%), and cough (4.5%).
Psychotic states may occur after using a variety of legal and illegal substances. Usually such states are temporary and reversible, with fluoroquinolone-induced psychosis being a notable exception. Drugs whose use, abuse, or withdrawal are implicated in psychosis include the following:
Psychosis manifests as disorientation, visual hallucinations and/or haptic hallucinations. It is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the capacity to deal with life demands. While there are many types of psychosis, substance-induced psychosis can be pinpointed to specific chemicals.
Tobacco smoking and pregnancy is related to many effects on health and reproduction, in addition to the general health effects of tobacco. A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the fetus.
Ideally, women should not smoke before, during or after pregnancy. If this is not the case, however, the daily number of cigarettes can be reduced to minimize the risks for both the mother and child. This is particularly important for women in developing countries where breastfeeding is essential for the child's overall nutritional status.
Green Tobacco Sickness (GTS) is a type of nicotine poisoning caused by the transdermal absorption of nicotine from the surface of wet tobacco plants. Tobacco harvesters, whose clothing becomes saturated from tobacco wet with rain or morning dew, are at high risk of developing GTS. Workers can avoid getting this sickness by waiting to harvest until the tobacco leaves are dry, or by wearing a rain suit. Wet clothing that has come in contact with tobacco leaves should be removed immediately and the skin washed with warm soapy water.
Nicotine from other sources, including nicotine gum, a nicotine patch or electronic cigarette, or other tobacco products like cigarettes or smokeless tobacco, appears to reduce the risk of GTS due to the body adapting to the intake of nicotine.
Symptoms of GTS include nausea, vomiting, headache, dizziness, and severe weakness. These symptoms may be accompanied by fluctuations in blood pressure or heart rate. Abdominal cramping, chills, increased sweating, salivation and difficulty breathing are also common. The illness will resolve on its own within one to two days, but symptoms may be so severe as to require emergency medical treatment.
Worldwide there are an estimated 33 million tobacco farm workers, with a substantial proportion living in developing countries. A recent international review reported that between 8-89% of tobacco harvesters may be affected in the course of a season (this wide variation probably being due to differences between study methodologies as well as a range of working conditions). The long-term health outcomes for individuals exposed to nicotine transdermally for extended periods of time are not known.
Users report feelings of relaxation, sharpness, calmness, and alertness. Those new to smoking may experience nausea, dizziness, increased blood pressure, narrowed arteries, and rapid heart beat. Generally, the unpleasant symptoms will eventually vanish over time, with repeated use, as the body builds a tolerance to the chemicals in the cigarettes, such as nicotine.
STK typically occurs in the buccal sulcus (inside the cheek) or the labial sulcus (between the lips and the teeth) and corresponds to the site where the tobacco is held in the mouth. It is painless.
The appearance of the lesion is variable depending upon the type of tobacco used, and the frequency and duration of use. It takes about 1-5 years of smokeless tobacco use for the lesion to appear. Early lesions may appear as thin, translucent and granular or wrinkled mucosa. The later lesion may appear thicker, more opaquely white and hyperkeratotic with fissures and folds. Oral snuff causes more pronounced changes in the oral mucosa than tobacco chewing. Snuff dipping is associated more with verrucous keratosis.
As well as the white changes of the oral mucosa, there may be gingival recession (receding gums) and staining of tooth roots in the area where the tobacco is held.
There are many types of smokeless tobacco. Chewing tobacco is shredded, air-cured tobacco with flavoring. Dipping tobacco ("moist snuff") is air or fire-cured, finely cut tobacco. Dry snuff is ground or pulverised tobacco leaves. In the Indian subcontinent, the Middle-East and South-East Asia, tobacco may be combined in a quid or paan with other ingredients such as betel leaf, Areca nut and slaked lime. Use of Areca nut is associated with oral submucous fibrosis. An appearance termed Betel chewer's mucosa describes morsicatio buccarum with red-staining of mucosa due to betel quid ingredients. In Scandinavian countries, snus, a variant of dry snuff, is sometimes used. In the United States of America, the most common form of smokeless tobacco is dipping tobacco, although chewing tobacco is sometimes used by outdoor workers and dry snuff is common among females in the Southern states. The overall prevalence of smokeless tobacco use in the USA is about 4.5%, but this is higher in Mid-Western and Southern states.
Lifestyle diseases are defined as diseases linked with the way people live their life. This is commonly caused by alcohol, drug and smoking abuse as well as lack of physical activity and unhealthy eating. Diseases that impact on our lifestyle are heart disease, stroke, obesity and type II diabetes. The diseases that appear to increase in frequency as countries become more industrialized and people live longer. They can include Alzheimer's disease, arthritis, atherosclerosis, asthma, cancer, chronic liver disease or cirrhosis, chronic obstructive pulmonary disease, type 2 diabetes, heart disease, metabolic syndrome, chronic renal failure, osteoporosis, stroke, depression, obesity and vascular dementia. In the U.K the death rate is four times higher from respiratory disease caused by an unhealthy lifestyle
Some commenters maintain a distinction between diseases of longevity and diseases of civilization. Certain diseases, such as diabetes, dental caries and asthma, appear at greater rates in young populations living in the "western" way; their increased incidence is not related to age, so the terms cannot accurately be used interchangeably for all diseases.
Primary polydipsia is a form of polydipsia characterised by excessive fluid intake in the absence of physiological stimuli to drink. This includes psychogenic polydipsia (PPD - not to be confused with postpartum depression), which is caused by psychiatric disorders, often schizophrenia, and often accompanied by the sensation of dry mouth. Some forms of primary polydipsia are explicitly non-psychogenic. Primary polydipsia is a diagnosis of exclusion.
In diagnosis, primary polydipsia is usually categorised as:
- Psychogenic (PPD) - caused by underlying psychiatric symptoms, including those caused by psychoses and rarely by affective disorders
- Non-psychogenic - another non-psychological cause, including idiopathic (unknown cause)
The terms primary polydipsia and psychogenic polydipsia are sometimes incorrectly used interchangeably - to be considered psychogenic, the patient needs to have some other psychiatric symptoms, such as delusions involving fluid intake or other unusual behaviours. Primary polydipsia may have physiological causes, such as autoimmune hepatitis.
Since primary polydipsia is a diagnosis of exclusion, the diagnosis may be made for patients who have medically unexplained excessive thirst, and this is sometimes incorrectly referred to as "psychogenic" rather than "primary" polydipsia.
Australia: A 2009 study found that 2,100 Australians die from alcohol-related cancer each year.
Europe: A 2011 study found that one in 10 of all cancers in men and one in 33 in women were caused by past or current alcohol intake.
Agoraphobia is a condition where sufferers become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as the agoraphobic fears the onset of a panic attack and appearing distraught in public. Most of the time they avoid these areas and stay in the comfort of their safe haven. This is also sometimes called "social agoraphobia", which may be a subtype of social anxiety disorder.
Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks". In these cases, the sufferer is fearful of a particular place because they have experienced a panic attack at the same location at a previous time. Fearing the onset of another panic attack, the sufferer is fearful or even avoids a location. Some refuse to leave their homes even in medical emergencies because the fear of being outside of their comfort areas is too great.
The sufferers can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is actually a symptom professionals check when making a diagnosis of panic disorder. Other syndromes like obsessive compulsive disorder or post-traumatic stress disorder can also cause agoraphobia. Essentially, any irrational fear that keeps one from going outside can cause the syndrome.
Agoraphobics may suffer from temporary separation anxiety disorder when certain other individuals of the household depart from the residence temporarily, such as a parent or spouse, or when the agoraphobic is left home alone. Such temporary conditions can result in an increase in anxiety or a panic attack or feeling the need to separate themselves from family or maybe friends.
Another common associative disorder of agoraphobia is thanatophobia, the fear of death. The anxiety level of agoraphobics often increases when dwelling upon the idea of eventually dying, which they may consciously or unconsciously associate with being the ultimate separation from their emotional comfort and safety zones and loved ones, even for those who may otherwise believe in some form of afterlife.
Occupational cancer is cancer caused by occupational hazards. Several cancers have been directly tied to occupational hazards, including chimney sweeps' carcinoma, mesothelioma, and others.