MODUL II HIDROSTATIKA 2.1. PENDAHULUAN • Hidrostatika merupakan bagian dari hidrolika yang mempelajari gaya-gaya tekan cairan dalam keadaan diam. • Karena cairan dalam keadaan diam maka tidak terdapat geseran baik antara lapisan cairan tersebut, maupun antara cairan dan batas padat. • Dengan demikian gaya-gaya yang bekerja hanya gaya- gaya normal yaitu gaya tekan yang bekerja tegak lurus pada permukaannya. • Di dalam bab ini akan dibahas gaya-gaya tekan yang bekerja pada benda yang berada di dalam cairan, keseimbangan gaya-gaya tekan dan keseimbangan relatif.
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Adolescent Substance Abuse Anthony Dekker, D.O. SWRSAC 2000.
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Adolescent Substance Abuse
Anthony Dekker, D.O.
SWRSAC 2000
“We live in a decadent age. Young people no longer respect their parents. They are rude and impatient. They frequent taverns and have no self-respect.”
Inscription on Egyptian tombcirca 3000 B.C.
• “Monitoring the Future” Study:
– NIDA, University of MichiganSince 1975, high school seniorsSince 1991, also 8th & 10th graders
• Those in school use less
• White seniors use > Hispanic > Black
• Peak drug use late 1970s - 1981
ADOLESCENT SUBSTANCE ABUSE
• 54.7% of seniors had ever used any illicit drug ( 0.6)
• 25.9% used in past month ( 0.3)• 43% believe > 5 drinks 1-2 times a
weekend is risky ()• 25% believe marijuana use once or
twice is risky ()
SUBSTANCE ABUSE TRENDS1999 MONITORING THE FUTURE
Lifetime 30 days Daily
Alcohol 80.0 51.0 3.4
Cigarettes 64.6 34.6 23.1
Smokeless 23.4 8.4 2.9
tobacco
Marijuana 49.7 23.1 6.0
MONITORING THE FUTURE1999 PREVALENCE OF USE (%)U.S. HIGH SCHOOL SENIORS
Lifetime 30 days Daily
Stimulants 16.3 4.5 0.3
Inhalants 15.4 2.0 0.2
Hallucinogens 13.7 3.5 0.1
MONITORING THE FUTURE1999 PREVALENCE OF USE (%)U.S. HIGH SCHOOL SENIORS
Lifetime 30 days Daily
Cocaine 9.8 2.6 0.2
Crack 4.6 1.1 0.2
Heroin 2.0 0.5 0.1
Steroids 2.9 0.9 0.2
Barbiturates 8.9 2.6 0.2
MONITORING THE FUTURE1999 PREVALENCE OF USE (%)U.S. HIGH SCHOOL SENIORS
• Childhood: parent use and behaviors, attitude, parenting, coping styles, family dysfunction, prevention efforts
• Adolescence: parent use & role-modeling, family expectations, permissiveness, tolerance of teen use & peer group, teen/peer ATOD* use & behaviors; HEADSSS
ANTICIPATORY GUIDANCEFAMILY CONTEXT
* alcohol, tobacco, and other drugs
• + Family history of alcoholism, addiction or antisocial behavior
• Family modeling of substance use behaviors
• Poor parenting skills, family dysfunction
• Permissive attitude toward teen use household conflict, family chaos
• Child abuse or neglect (physical, sexual)
POTENTIAL RISK FACTORSGENETIC AND FAMILY FACTORS
interest in school and achievement, early academic failure
self-esteem religious activity• Rebelliousness and social alienation• Early antisocial behavior, delinquency• Psychopathology, esp. depression• Early risk behaviors: ATOD, sex
• PATIENT NOT USING– Affirm decision not to use– Anticipatory guidance
• PATIENT USING/LOWER RISK– State your concern– Elicit patient’s understanding of use. Dispel myths– Assess readiness to change– Negotiate plan and follow up
SYNTHESIS AND PROCESS
• PATIENT USING/HIGHER RISK– State your concern– Elicit patient’s understanding of use. Dispel myths– Assess readiness to change– Prepare patient/family for referral– Negotiate plan and follow up
SYNTHESIS AND PROCESS
is an interpersonal interaction whose primary impact is motivational, working to trigger a decision and commitment to change
BRIEF INTERVENTION
Pre-contemplationContemplation
Action PlanImplementationMaintenance
RecoveryRelapse
MOTIVATIONAL INTERVIEWING
• is a particular way to help people recognize and do something about their present or potential behavioral problems, including AODA use
• motivates a person to resolve ambivalence and to get moving along the path of change
MOTIVATIONAL INTERVIEWING
• Express empathy• Develop discrepancy• Avoid argumentation• Roll with resistance• Support self-efficacy
PRINCIPLES OFMOTIVATIONAL INTERVIEWING
• Practitioner uncertain or inexperienced• Frequent, regular or compulsive use• Concurrent psychopathology• Impaired function: school, legal, work or social (family, peers, etc.)• Certain circumstances: imminent health risk, behavior presents danger to self or
others• Inability to use or maintain abstinence
WHEN IS REFERRAL NEEDED?
• Local chapter of national groups:– SADD, MADD, NFP, Safe Rides, DARE
• Focus: awareness, education, action– positive peer role-modeling– promote parent involvement– various projects: hotlines, safe rides, lobby, media i.e., SADD “Contract for Life”
COMMUNITY-BASED INITIATIVES
• Teens more often abuse multiple drugs– smorgasbord vs. drug of choice
• Multiple drug use/overdose effects are more difficult to interpret and treat
• Street drugs often misrepresented– toxic on other than alleged drug– overdose represents drug combination
SUBSTANCE ABUSEGENERAL ISSUES
• Nicotine effects and addiction, “gateway” drug• Teen users more likely to become smokers• Leukoplakia; various oral cancers: gum, mouth, pharynx, larynx, esophagus• Periodontal disease: gingivitis, recession• Tooth and filling staining, abrasion of teeth, caries, halitosis• Hypertension, vasoconstriction
SMOKELESS TOBACCOHEALTH CONSEQUENCES
• Solvents– industrial or household– art or office supply
• Gases– in household or commercial products– household aerosol propellants– medical anesthetic gases
• Nitrites– aliphatic nitrites
CATEGORIES OF INHALANTS
• ACUTE: – anesthesia, intoxication, quick “drunk”– initial excitement turns to drowsiness– disinhibition, lightheaded, agitation, HA– ataxia, dizzy, disoriented, dysarthria, weakness, nystagmus, loss of
consciousness– sensitization to endogenous catecholamines
GENERAL INHALANT EFFECTS
• CHRONIC: – weight loss– muscle weakness– general disorientation– inattentiveness– lack of coordination
GENERAL INHALANT EFFECTS
• IRREVERSIBLE: – Hearing loss– Peripheral neuropathies or limb spasms– CNS or brain damage– Hematologic: dyscrasias