This client should be contacted first to assess for signs/ symptoms of digoxin toxicity hair loss 6mp generic propecia 1mg line. The glycosylated hemoglobin hair loss in men experience discount 1mg propecia free shipping, which is the average of blood glucose levels over 3 months female hair loss in male pattern order propecia 1mg free shipping, should not be more than 8% hair loss cure exfoliating buy 1mg propecia mastercard. The nurse should call and arrange a time convenient for the visit hair loss in men makeup effective propecia 1 mg, but the nurse should first review the client referral so the nurse is aware of the need for the visit hair loss cure stem cell generic propecia 5 mg mastercard. The nurse may need to contact the referring agency if the information is unclear or if important information is missing hair loss in men 60 buy propecia 1 mg with visa. The nurse will not know which referrals will be needed until after the first visit hair loss young living order 5 mg propecia. The client should be encouraged to exercise, but it should be in a supervised setting such as a cardiac rehabilitation unit because the client has diabetes and hypertension. The client should adhere to a low-fat, low-cholesterol, carbohydrate-counting diet, but this is not the priority intervention. The client needs to be in a supervised setting, and diet teaching is included in cardiac rehabilitation. Cardiac rehabilitation includes progressive exercise, diet teaching, and classes on modifying risk factors. The client should lose weight slowly, but the priority intervention for this client would be a referral to a supervised setting where the client can lose weight slowly and safely. If the client or family is intoxicated, hostile, or obnoxious, the nurse should leave and reschedule the visit. There is no need to call the police unless the nurse thinks he or she will be hurt. The agency should be informed of the schedule so the nurse can be located if the nurse does not return when expected. The employee should not date any relatives of the client because this may pose a conflict of interest. Keeping the head of the bed elevated will help the client breathe easier; therefore, this is an appropriate teaching intervention. Telling the client to avoid eating foods high in sodium is an appropriate teaching intervention. Isotonic exercise, such as walking or swimming, helps tone the muscles, and discussing this with the client is an appropriate teaching intervention. The client will be cared for in the home and the nurse must know who is available to help the client. The nurse should stay with the client and her husband and not make any liferescuing interventions while the client is dying. This client should be seen, but a client who is terminally ill and is refusing to eat is not an emergency situation. This client should be seen first so that appropriate pain control can be obtained immediately. A Stage 1 pressure ulcer must be assessed and treatment started but this is not priority over pain control. Do not assign a task to a staff member that requires a higher level of expertise than that staff member has. Conversely, do not assign a task to a staff member when that task could be performed by a staff member with a lower level of expertise. In a hospital, the respiratory therapist assumes the responsibility for ventilations. The nursing supervisor is responsible for requesting the family to leave the room. Do not assign a task to a staff member that requires a higher level of expertise or that a staff member with a lower level of expertise could perform. Clients should be encouraged to discuss their life because life review may help clients accept their death. If the family is not causing a disruption in the code, the family member should be allowed to stay in the room with the supervisor remaining near the family member and explaining why the interventions are being implemented will help the client to survive. The supervisor should be ready to escort the family member out of the code if the family member becomes disruptive. This will cause ill will on the part of the family and could result in the filing of a needless lawsuit. Ignoring the family member could cause a problem; the supervisor should be proactive in managing the situation. Federal law requires that clients presenting to an emergency department must be assessed and treated without regard to payment. If a transfer is made, it will be after the client has been stabilized and the receiving hospital has accepted the transfer. The hospital will attempt to recover the costs after the client has been treated, 4. First-dose intravenous antibiotic medications are priority medications and should be administered within 1 to 2 hours of when the order was written. A statin medication that decreases cholesterol level should be administered in the evening when the enzyme for cholesterol metabolism is at its highest peak. As the rationale explains, antibiotic therapy should be initiated as soon as possible; a delay could cause death of the client. The nurse checks an apical pulse, not a radial pulse, prior to administering digoxin. There is no serum amiodorone level; therefore, the nurse cannot implement this intervention. The client with angina should be asymptomatic; when the client is complaining of chest pain, this is abnormal data. The client diagnosed with aortic valve stenosis has the classic triad of syncope, angina, and exertional dyspnea; therefore, this client would not be assessed first. This type of question is be aware of interventions that must be implemented prior to administering medications. The client would be expected to be drowsy after a narcotic preoperative medication. Whenever there is a discrepancy on the chart or with what the client says, the nurse should call an immediate time-out until the situation has been resolved. Because this is what is supposed to happen, the nurse would not need to call a time-out. This should be done immediately prior to administering the medication at the bedside. The nurse should not administer an antiplatelet medication to a client going to surgery because this will increase postoperative bleeding. The nurse should administer a unit of blood over the greatest length of time possible (4 hours) to a client diagnosed with congestive heart failure to prevent fluid volume overload. If the client is in distress, assessment is not the first intervention if there is an action the nurse can take to relieve the distress. Calling for an electrocardiogram and troponin level should be implemented but not before administering the nitroglycerin. The nurse should not document that the client fell unless the nurse observed the client fall. The home health aide is responsible for assisting the client with activities of daily living and transferring from the bed to the chair. Sitting outside is good for the client and is a task that can be delegated to the home health aide. The supervisor can take notes documenting the code until relieved, but the supervisor needs to be free to supervise the code and coordinate room assignments and staffing. The first intervention for the supervisor is to ensure that all the jobs in the code are being filled. This is the responsibility of the supervisor, but it is not the first intervention. The supervisor can administer medications, but the supervisor needs to be flexible to complete the duties of the supervisor. The administrative manager is responsible for the other members of the healthcare team. This client is being treated, and if the blood is almost finished, then it can be assumed that the client is tolerating the blood without incident. The nurse could arrange for the dietician to consult with the client about food preferences, but this client does not need to be assessed first. If the data is normal then a client with a psychosocial problem is the client the nurse should assess first. The charge nurse should make sure that the drip is maintaining the client in the therapeutic range, but the safety of the client going to surgery is first priority. This client is scheduled for surgery this morning; therefore, the charge nurse must make sure that he is stable for the procedure and notify the surgeon if there is any reason to question the safety of the client having the procedure this morning. Gall bladder disease is not life threatening, although it can be very uncomfortable. Nitroglycerin is administered first because it will dilate the vessels and resolve the cause of the chest pain. The nurse should administer the medication that will have the most rapid onset and directly resolve the problem. Nitroglycerin is a potent vasodilator and will dissolve rapidly under the tongue (sublingually). The nurse should assess the client and the temperature to see if interventions should be initiated based on a progression of the septicemia. This client should be assessed to be sure that the client is stable because there was chest pain during the last shift. The nurse should assess the client next because although confusion is expected, the nurse must determine whether any new situation is occurring. This client has a psychosocial need but it must be addressed and steps implemented to resolve the problem. This is a physiological situation but not a life-threatening one and the nurse should see this client when he/she has time to perform the dressing change. Nitroglycerin tablets are vasodilators that are administered to dilate the coronary vessels and provide oxygen to the heart muscle. Exercise is the probable cause of the chest pain; therefore, the activity should immediately stop. Supplemental oxygen will assist in getting higher concentrations of oxygen to the heart muscle. A ward secretary cannot take orders; only a nurse should discuss the client with the healthcare provider. Rationales for why the other possible answer options are incorrect also are given, but they are not in boldface type. Praxada is a medication specifically prescribed to prevent clotting in clients who have atrial fibrillation. Any nurse could administer the first dose of the medication; it would not have to be the most experienced nurse. Occasional premature ventricular contractions are experienced by most individuals and this client would not require the most experienced nurse. The Rapid Response Team is called if the client is in a potentially life-threatening situation and the nurse must first determine if the leads are on the client. The client probably has coronary artery disease and a low-fat, low-cholesterol diet would be expected. Intravenous morphine is the drug of choice for chest pain; therefore, this order would not be questioned. An endoscopy is not an usual diagnostic test for a client diagnosed with R/O myocardial infarction; therefore, Ms. The nurse cannot delegate assessment, teaching, evaluation, medications, or an unstable client. A client who is hypovolemic is not stable; therefore, this task cannot be delegated. This is the first medication administered during a code but the nurse first determines if the client has a pulse. This is appropriate intervention if the client has no pulse but the nurse first determines if the client has a pulse. Nitroglycerin tablets lose efficacy when exposed to sunlight; therefore, keeping the tablets in a dark bottle indicates the client understands the teaching. A sedentary lifestyle is a modifiable risk factor for atherosclerosis, which causes angina, so walking three times a week is an appropriate intervention. Decreasing the number of cigarettes a day indicates the client needs more teaching. A daily aspirin will help prevent platelet aggregation; therefore, this indicates the client understands the discharge teaching. The client on strict bed rest who is complaining of calf pain and has a reddened calf. Which statement concerning laboratory data is most important for the charge nurse to tell the unit secretary The nurse on the vascular unit is preparing to administer medications to clients on a medical unit. The client with a deep vein thrombosis who is complaining of dyspnea and coughing. The female client diagnosed with atherosclerosis tells the clinic nurse her stomach hurts after she takes her morning medications. The nurse educator on a vascular unit is discussing delegation guidelines to a group of new graduates. The nurse is reviewing the literature to identify evidence-based practice research that supports a new procedure using a new product when changing the central line catheter dressing. The article in which the study was conducted by the manufacturer of the product used. The review-of-literature article that cited ambiguous statistics about the product. The review-of-literature article that cited numerous studies supporting the product. The nurse and the unlicensed assistive personnel are caring for clients on a vascular unit. Fifteen minutes after initiation of the blood transfusion, the client becomes restless and complains of itching on the trunk and arms. The staff nurse on a vascular disorder unit asks the charge nurse, "What should I be looking for when I read a research article A client on the vascular unit tells the day shift primary nurse that the night nurse did not answer the call light for almost 1 hour. The nurse is preparing to administer a unit of packed red blood cells to an elderly client who is 1 day postoperative abdominal aortic aneurysm. The elderly client diagnosed with deep vein thrombosis is complaining of chest pain during inhalation. Which laboratory data should the nurse in the long-term care unit notify the healthcare provider about The occupational nurse is caring for the client who just severed two fingers from the right hand. The subcutaneous low-molecular-weight heparin to the client with a pulmonary embolus. Which priority intervention should the nurse discuss with the client when teaching about arterial hypertension Explain the need for the client to take antihypertensive medications as prescribed. The nurse on the vascular unit is caring for a client diagnosed with arterial occlusive disease. Contact the local fire department to see if they can provide smoke detectors for the client. The nurse is admitting a 72-year-old female client and notes multiple bruises on the face, arms, and legs along with possible cigarette burns on her upper arms. The male client with peripheral vascular disease tells the nurse, "I know my foot is really bad. The nursing staff confronts the hospice nurse overseeing the care of a client in a longterm care facility. The nursing staff wants to send the client who is diagnosed with gangrene of the left leg secondary to peripheral occlusive disease to the hospital for treatment. The client diagnosed with an abdominal aortic aneurysm died unexpectedly, and the nurse must notify the significant other. The nurse has been pulled from a medical unit to work on the vascular unit for the shift.
Syndromes
Absence of urine output
Location of the sting
Cystic fibrosis
Cuts, scrapes, wounds, insect bites and minor skin infections
Drug abuse and dependence
What other symptoms do you have? (for example, sore throat)
Nausea
Swelling under or around the eye (may affect both eyes)
Use and indications the main use of cola seed is as a stimulant for depression hair loss cure in 2017 1mg propecia with mastercard, tiredness and poor appetite hair loss in male cats propecia 1mg without prescription, and as a diuretic lakme prevention shampoo hair loss propecia 1 mg discount. Evidence hair loss therapy cure power grow laser purchase propecia 1mg without a prescription, mechanism hair loss in men 0f buy generic propecia 5 mg, importance and management There is a possibility that the effect of cola on blood pressure might differ from that of pure caffeine hair loss kidney disease buy propecia 1 mg on line. There appear to be very few published studies of the effect of cola on blood pressure; however hair loss jokes safe 1 mg propecia, in the Nurses Health prospective cohort studies hair loss cure taiwan cheap propecia 1mg on-line, both sugared cola and diet cola beverages were associated with an increased risk of developing hypertension with increased intake. However, the modest hypertensive effects of the caffeine content of cola may be of importance. See Caffeine + Antihypertensives, page 99, for further discussion of the adverse effect of caffeine on blood pressure. Clinical evidence In a study in 15 healthy subjects, a single 500-mg dose of halofantrine was given alone or with cola 12. Similar reductions were seen in the major metabolite of halofantrine, N-desbutylhalofantrine. Mechanism the authors suggest that caffeine, or other consituents of cola such as catechins or tannins, may have formed a complex with halofantrine to reduce its absorption. Importance and management Evidence appears to be limited to this one study, which found a modest reduction in the bioavailabilty of halofantrine. Nevertheless, as there is the potential that this interaction could lead to malaria treatment failure, it may be prudent to advise patients to avoid taking cola during treatment with halofantrine. Note that the effects of caffeine from cola-containing herbal medicine or supplement will be additive with those of other caffeinecontaining foods or beverages. Cola + Herbal medicines Cola + Halofantrine Cola appears to moderately reduce the bioavailability of halofantrine. The caffeine content of cola suggests that it may interact with other herbal medicines in the same way as caffeine, see Caffeine + Herbal medicines; Bitter orange, page 101, and Ephedra + Caffeine, page 176. Constituents the leaves and flowers of coltsfoot contain mucilage composed of polysaccharides, which include arabinose, fructose, galactose, glucose and xylose, and the carbohydrate inulin. Flavonoids (such as rutin, isoquercetin and hyperoside), polyphenolic acids, triterpenes and sterols are present, and sesquiterpenes including bisabolene derivatives and tussilagone may also be found. All parts of the plant may contain the pyrrolizidine alkaloids isotussilagine, senecionine, senkirkine and tussilagine in variable amounts. Extracts have anti-inflammatory and antispasmodic activity and tussilagone alone has been found to be a cardiovascular and respiratory stimulant. The concentration of the most toxic pyrrolizidine alkaloid, senkirkine, is thought to be too low to cause toxicity if used infrequently, and tussilagine is unsaturated and therefore less toxic. Use and indications Coltsfoot is traditionally used in cough and cold preparations Interactions overview No interactions with coltsfoot found. For information on the pharmacokinetics of the alkaloid constituent, berberine, see under berberine, page 58. Constituents the thread-like rhizomes contain isoquinoline alkaloids, mainly berberine and coptisine. However, for the interactions of the alkaloid constituent, berberine, see under berberine, page 58. Use and indications Coptis species are used widely in Chinese medicine for 151 Cranberry Vaccinium macrocarpon Aiton (Ericaceae) C Synonym(s) and related species Large cranberry (Vaccinium macrocarpon) is the cultivated species. Constituents the berries contain anthocyanins and proanthocyanidins (mainly oligomers of epicatechin), and organic acids including malic, citric, quinic and benzoic acids. Note that, although salicylic acid does not appear as a constituent of the juice in many cranberry monographs, some studies have shown low levels of salicylates in commercial cranberry juice. The urinary levels of anthocyanins reached a maximum between 3 and 6 hours, and the recovery of total anthocyanins in the urine over 24 hours was estimated to be 5% of the amount consumed. Interactions overview Clinical studies suggest that cranberry juice and/or extracts do not affect the pharmacokinetics of ciclosporin, flurbiprofen, midazolam, tizanidine and warfarin. Cranberry juice is unlikely to affect the pharmacokinetics of nifedipine to a clinically relevant extent. Increased salicylate concentrations in urine of human volunteers after consumption of cranberry juice. Use and indications the main use of cranberries and cranberry juice is for the prevention and treatment of urinary tract infections, although they have also been used for blood and digestive disorders. Pharmacokinetics There is high absorption and excretion of cranberry anthocyanins in human urine, as shown by a study where 152 Cranberry 153 Cranberry + Ciclosporin Occasional consumption of cranberry juice does not appear to affect the bioavailibility of ciclosporin. Evidence, mechanism, importance and management In a well-controlled, single-dose study, 12 healthy fasted subjects were given a 200-mg dose of oral ciclosporin simultaneously with 240 mL of cranberry juice or water. Cranberry juice was found to have no clinically significant effect on the pharmacokinetics of ciclosporin. This study suggests that cranberry juice does not affect the absorption of ciclosporin, and that drinking the occasional glass of cranberry juice with ciclosporin should not affect ciclosporin levels. However, note that a study of regular daily cranberry juice consumption is required to also rule out an interaction affecting ciclosporin elimination, which may have a bearing on the safety of regular. Pomelo juice, but not cranberry juice, affects the pharmacokinetics of cyclosporine in humans. C Cranberry + Midazolam Limited evidence suggests that cranberry juice does not appear to affect the pharmacokinetics of midazolam. Clinical evidence In a randomised, crossover study in 10 healthy subjects, 200 mL of cranberry juice three times daily for 10 days had no significant effect on the pharmacokinetics of a single 500-microgram oral dose of midazolam taken on day 5. In this study, the cranberry juice used was a concentrate (Kontiomehu sokeroitu karpalomehu) diluted 1 to 4 with tap water before use. Cranberry + Flurbiprofen Limited evidence suggests that cranberry juice does not appear to affect the pharmacokinetics of flurbiprofen. Clinical evidence In a study in 14 healthy subjects, 230 mL of cranberry juice taken the night before, and 30 minutes before a single 100-mg dose of flurbiprofen, had no significant effect on the pharmacokinetics of flurbiprofen. Experimental evidence In an in vitro study, cranberry juice inhibited flurbiprofen hydroxylation by about 44%, which was less than that of the positive control sulfaphenazole (79%). Therefore no dosage adjustment appears to be necessary if patients taking flurbiprofen wish to drink cranberry juice. Importance and management Although the evidence is limited to this particular study, there appears to be no need for special precautions when taking cranberry juice with midazolam. Cranberry + Nifedipine the interaction between cranberry juice and nifedipine is based on experimental evidence only. However, other pharmacokinetic parameters such as the mean residence time, volume of distribution, and elimination rate constant were not significantly affected. The patient was drinking almost 2 litres of cranberry juice daily, because of recurrent urinary tract infections, and was advised to stop drinking this. The cranberry concentrate had no effect on platelet aggregation, and had no effect on the pharmacokinetics of either R- or S-warfarin. Importance and management Evidence appears to be limited to two experimental studies. Taken on its own, this evidence suggests the possibility of a modest interaction, and therefore some caution might be warranted in patients taking nifedipine who drink cranberry juice. C Cranberry + Tizanidine Limited evidence suggests that cranberry juice does not appear to affect the pharmacokinetics of tizanidine. Clinical evidence In a randomised, crossover study in 10 healthy subjects 200 mL of cranberry juice three times daily for 10 days had no significant effect on the pharmacokinetics of a single 1-mg oral dose of tizanidine taken on day 5. Importance and management Although the evidence is limited to this particular study, there appears to be no need for any special precautions when taking cranberry juice with tizanidine. For example, the salicylate constituent of commercial cranberry juice might cause hypoprothrombinaemia. Controlled studies have not found a pharmacokinetic interaction, and only one of four studies found any evidence for an increase in warfarin effect. This might be explained if the interaction is dose dependent (in one of the cases where cranberry intake was mentioned a quantity of 2 litres daily was being consumed), or if it is product dependent. However, it could also be that there is no specific interaction, and that the case reports just represent idiosyncratic reactions in which other unknown factors. Committee on Safety of Medicines/Medicines and Healthcare products Regulatory Agency Possible interaction between warfarin and cranberry juice. Committee on Safety of Medicines/Medicines and Healthcare products Regulatory Agency Interaction between warfarin and cranberry juice: new advice. Warfarin-cranberry juice interaction resulting in profound hypoprothrombinemia and bleeding. A randomized, double-blind trial of the interaction between cranberry juice and warfarin. Pharmacodynamic interaction of warfarin with cranberry but not with garlic in healthy subjects. C Creatine N-(Aminoiminomethyl)-N-methylglycine C Types, sources and related compounds Creatine monohydrate. Use and indications Creatine supplements are taken most often to improve exercise performance and increase muscle mass. Creatine is found in foods, most abundantly in meat and fish, and is also synthesised endogenously. Excessive intake of creatine, by the use of supplements, has, very rarely, been reported to cause acute renal impairment. The maximum plasma level of creatine is reached less than 2 hours after the ingestion of doses of under 10 g, but after more than 3 hours for doses over 10 g, and may vary with the ingestion of carbohydrate, see food, page 157. Clearance of creatine would appear to be dependent on both skeletal muscle and renal function. There is an isolated report of stroke in a patient taking a creatine supplement with caffeine plus ephedra, although the role of creatine in this case is uncertain. There is a possibility that creatine supplements might complicate interpretation of serum creatinine measurement. Pharmacokinetics Creatine is distributed throughout the body, with the majority being found in skeletal muscle. Creatine is degraded to creatinine, and both creatine and creatinine are excreted via the kidneys. Absorption of creatine is likely to be an active process, and may follow nonlinear kinetics with the 156 Creatine 157 Creatine + Caffeine Limited evidence suggests that the performance-enhancing effects of creatine may be reduced by caffeine. Clinical evidence Nine healthy subjects given a creatine supplement 500 mg/kg daily for 6 days, and caffeine capsules 5 mg/kg daily for 3 days beginning on the fourth day, experienced a lack of performance-enhancing effects of creatine during knee extension exercises, when compared with creatine given alone. Caffeine 5 mg/kg reduced phosphocreatine resynthesis during rest from a period of exercise when given with creatine 25 g daily for 2 or 5 days. Importance and management these studies are preliminary and there seem to be no further reports of an interaction. However, those taking creatine supplements to enhance exercise performance should perhaps reduce caffeine intake from beverages and other sources. Note that caffeine is also present in a number of herbal medicines, consider also caffeine-containing herbs, page 97. Inhibition of muscle phosphocreatine resynthesis by caffeine after creatine loading. Carbohydrate ingestion augments creatine retention during creatine feeding in humans. Protein- and carbohydrate-induced augmentation of whole body creatine retention in humans. C Creatine + Herbal medicines; Ephedra with Caffeine There is an isolated report of stroke in a patient taking a creatine supplement with ephedra plus caffeine, although the role of creatine in this case is uncertain. Evidence, mechanism, importance and management A 33-year-old fit man with no vascular risk factors had a stroke 6 weeks after starting to take two supplements to aid body building. The first contained ephedra alkaloids (from ma huang), caffeine, levocarnitine and chromium, and the second contained creatine, taurine, inosine and coenzyme Q10. His daily consumption was estimated to be 40 to 60 mg of ephedra alkaloids, 400 to 600 mg of caffeine and 6 g of creatine. Therefore, this case could be attributed to this supplement alone, and the role of creatine is unclear. Ischaemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for body building. Creatine + Food Limited evidence suggests that a high carbohydrate intake may increase creatine retention. Clinical evidence In a study, 22 healthy male subjects were given 5 g creatine alone, or with 500 mL Lucozade (which provided a source of glucose and simple sugars) every 4 to 5 hours, giving a total dose of creatine of 20 g daily for 2 days. Subjects who received creatine alone continued their normal diet, whereas those receiving creatine with Lucozade received a high-carbohydrate diet. Mechanism the authors suggested that their findings indicate that the ingestion of carbohydrate with creatine led to an increase in insulin secretion, Creatine + Laboratory tests There is a possibility that creatine supplements might complicate the interpretation of serum creatinine measurement. Evidence, mechanism, importance and management Creatinine is produced in muscles from the breakdown of creatine, and is excreted by the kidneys. Blood levels of creatinine are therefore used as one measure to estimate renal function. It is possible that dietary supplementation with creatine could lead to increased serum levels of creatinine, and this might be particularly so in patients with impaired renal function and with long-term use. It would be sensible for individuals taking creatine supplements to tell their health provider this fact, if they need to have renal function tests. Use and indications Damiana is used most often as an aphrodisiac, but, although there are some animal studies, there is no clinical evidence to support this use. D Constituents Damiana leaves contain flavonoids including trimethoxyflavone derivatives. The hydroquinone arbutin, a cyanogenetic glycoside tetraphylline B and the phytosterol -sitosterol have also been reported. The volatile oil contains, among other components, - and -pinene, thymol, -copaene, -cadinene and calamene. For information on the pharmacokinetics of individual flavonoids present in dandelion, see under flavonoids, page 186. D Constituents the root and leaf of dandelion contain sesquiterpene lactones including: taraxinic acid, dihydrotaraxinic acid, taraxacoside, taraxacolide and others; caffeic, chlorogenic and cichoric acids; the natural coumarins cichoriin and aesculin; and flavonoids based on luteolin. The phytosterols sitosterol, stigmas terol, taraxasterol and homotaraxasterol, the triterpenes -amyrin, taraxol and taraxerol, carotenoids, and vitamin A are also found. Interactions overview No interactions specific to dandelion, although there is limited evidence from animals that Taraxacum mongolicum (the species used in Chinese medicine) might alter the absorption of ciprofloxacin. For information on the interactions of individual flavonoids present in dandelion, see under flavonoids, page 186. Use and indications Dandelion has been widely used as a diuretic, and also for its purported laxative, anti-inflammatory, choleretic (to increase bile secretion) and blood-glucose-lowering activity. Some of these activities have been demonstrated in some, but not all, animal studies, and no human studies appear to have been published. Further study is required to discover if, and under what circumstances, dandelion might interact with ciprofloxacin in clinical use. Also, study is needed to see whether the effects of the dandelion species used in this study (Taraxacum mongolicum) apply to Taraxacum officinalis. Effects of Taraxacum mongolicum on the bioavailability and disposition of ciprofloxacin in rats. Dandelion + Ciprofloxacin the interaction between Taraxacum mongolicum and ciprofloxacin is based on experimental evidence only. Experimental evidence In a study in rats, an aqueous extract of Taraxacum mongolicum (2 g crude drug/kg) significantly reduced the maximum concentration of a single 20-mg/kg oral dose of ciprofloxacin by 73% when compared with administration of oral ciprofloxacin alone. The Taraxacum mongolicum extract used was analysed and found to have a high concentration of magnesium, calcium and iron. The reason for the reduced maximum level and prolonged elimination half-life is uncertain. Danshen Salvia miltiorrhiza Bunge (Lamiaceae) Synonym(s) and related species Chinese salvia, Dan-Shen, Red root sage, Tan-Shen. Other constituents include fatty-acid (oleoyl) derivatives, lithospermic acid B, and salvinal (a benzofuran) and nitrogen-containing compounds such as salvianen. D Use and indications the dried root of danshen is traditionally used in Chinese medicine for cardiovascular and cerebrovascular diseases, specifically angina pectoris, hyperlipidaemia and acute ischaemic stroke, but also palpitations, hypertension, thrombosis and menstrual problems. It is also used as an anti-inflammatory and for the treatment of cancer and liver disease. Interactions overview Some case reports and animal data indicate that danshen can, rarely, increase the effects of warfarin, resulting in bleeding. The antiplatelet activity of danshen may be partly responsible, and therefore additive antiplatelet effects might occur if danshen is taken with conventional antiplatelet drugs, which may also increase the risk of bleeding. Danshen can falsify the results of serum immunoassay methods for digoxin, and experimental evidence suggests that danshen could raise digoxin levels. Additive blood-pressure-lowering effects could, in theory, occur if danshen is taken with nifedipine, but no clinically relevant pharmacokinetic interaction appears to occur. Clinical evidence suggests that danshen does not affect the pharmacokinetics of theophylline, and experimental evidence suggests that danshen does not affect the pharmacokinetics of alcohol, or tolbutamide. Pharmacokinetics Limited in vitro and animal studies suggest that danshen extracts affect the activities of various cytochrome P450 isoenzymes. Pharmacological evidence for calcium channel inhibition by danshen (Salvia miltiorrhiza) on rat isolated femoral artery. Danshen + Alcohol the interaction between danshen and alcohol is based on experimental evidence only. Experimental evidence An oral danshen extract 200 mg/kg inhibited the oral absorption of alcohol in rats. Danshen had no effect on blood-alcohol levels when ethanol was injected intraperitoneally. Importance and management Evidence for an interaction between alcohol and danshen appears to be limited to one study in rats. Even if these results are replicated in humans, any effect is probably not clinically relevant, and danshen is certainly not proven for use as an aid to reducing alcohol absorption or lowering blood-alcohol levels. Salvia miltiorrhiza extract inhibits alcohol absorption, preference, and discrimination in sP rats. Danshen + Digoxin the interaction between danshen and digoxin is based on experimental evidence only.
New trends encouraged people to live more healthful lifestyles by placing an emphasis on exercise and nutrition hair loss 9 months after baby discount propecia 5mg with amex. There was also greater access to information about the health risks of behaviors such as cigarette smoking hair loss cure laser generic propecia 5mg online, alcohol consumption hair loss due to thyroid problems propecia 1 mg overnight delivery, and drug use hair loss in young males 1 mg propecia sale. Because they were healthier hair loss 3 months after giving birth purchase 1mg propecia, many older people continue to work past the typical retirement age and provide more opportunity to save for retirement hair loss in patches proven 1mg propecia. In the meantime hair loss cure oil buy generic propecia 1 mg line, they are realizing the immediate impact of the recession on elderly poverty hair loss shampoo buy propecia 5 mg on-line. From October 2007 to October 2009 the values of retirement accounts for people over age fifty lost 18 percent of their value. The sharp decline in the stock market also forced many to delay their retirement (Administration on Aging 2009). The speed limit was thirty-five miles per hour, and while most drivers sped along at forty to fortyfive mph, the driver in front of him was going the minimum speed. She paid for her groceries, lifted her bags of food into her cart, and toddled toward the exit. Peter, guessing her to be about eighty years old, was reminded of his grandmother. He assumed the driver drove cautiously simply because the man was a senior citizen, and he assumed the shopper needed help carrying her groceries just because she was an older woman. Robert Butler coined the term in 1968, noting that ageism exists in all cultures (Brownell). Ageist attitudes and biases based on stereotypes reduce elderly people to inferior or limited positions. When ageism is reflected in the workplace, in healthcare, and in assisted-living facilities, the effects of discrimination can be more severe. Ageism can make older people fear losing a job, feel dismissed by a doctor, or feel a lack of power and control in their daily living situations. In some countries today, the elderly still have influence and power and their vast knowledge is respected. Reverence for the elderly is still a part of some cultures, but it has changed in many places because of social factors. In many modern nations, however, industrialization contributed to the diminished social standing of the elderly. Some older members of the workforce felt threatened by this trend and grew concerned that younger employees in higher level positions would push them out of the job market. Rapid advancements in technology and media have required new skill sets that older members of the workforce are less likely to have. The oldest members of the family contributed to the household by doing chores, cooking, and helping with child care. As economies shifted from agrarian to industrial, younger generations moved to cities to work in factories. What began during industrialization, a trend toward older people living apart from their grown children, has become commonplace. Mistreatment and Abuse Mistreatment and abuse of the elderly is a major social problem. As expected, with the biology of aging, the elderly sometimes become physically frail. This frailty renders them dependent on others for care-sometimes for small needs like household tasks, and sometimes for assistance with basic functions like eating and toileting. Unlike a child, who also is dependent on another for care, an elder is an adult with a lifetime of experience, knowledge, and opinions-a more fully developed person. Elder abuse occurs when a caretaker intentionally deprives an older person of care or harms the person in his or her charge. Caregivers may be family members, relatives, friends, health professionals, or employees of senior housing or nursing care. Ron Acierno, the team of researchers identified five major categories of elder abuse: 1) physical abuse, such as hitting or shaking, 2) sexual abuse, including rape and coerced nudity, 3) psychological or emotional abuse, such as verbal harassment or humiliation, 4) neglect or failure to provide adequate care, and 5) financial abuse or exploitation (Acierno 2010). Administration on Aging, also identifies abandonment and self-neglect as types of abuse. Some social researchers believe elder abuse is underreported and that the number may be higher. The risk of abuse also increases in people with health issues such as dementia (Kohn and Verhoek-Oftedahl 2011). Older women were found to be victims of verbal abuse more often than their male counterparts. Other studies have focused on the caregivers to the elderly in an attempt to discover the causes of elder abuse. Researchers identified factors that increased the likelihood of caregivers perpetrating abuse against those in their care. A history of depression in the caregiver was also found to increase the likelihood of elder abuse. Many of the caregivers who physically abused elders were themselves abused-in many cases, when they were children. Family members with some sort of dependency on the elder in their care were more likely to physically abuse that elder. For example, an adult child caring for an elderly parent while at the same time depending on some form of income from that parent, is considered more likely to perpetrate physical abuse (Kohn and Verhoek-Oftedahl 2011). Paid caregivers in nursing homes were at a high risk of becoming abusive if they had low job satisfaction, treated the elderly like children, or felt burnt out (Kohn and Verhoek-Oftedahl 2011). Caregivers who tended to be verbally abusive were found to have had less training, lower education, and higher likelihood of depression or other psychiatric disorders. Based on the results of these studies, many housing facilities for seniors have increased their screening procedures for caregiver applicants. Most of these men and women were in their late teens or twenties when they served. Veterans Administration (National Center for Veterans Analysis and Statistics 2011). These heroes did not receive the mental and physical healthcare that could have helped them. Research has found that veterans of any conflict are more than twice as likely as nonveterans to commit suicide, with rates highest among the oldest veterans. Unfortunately, many were in their eighties and were neither physically nor financially able to travel on their own. Morse arranged to personally escort some of the veterans and enlisted volunteer pilots who would pay for the flights themselves. The round-trip flights leave for day-long trips from airports in thirty states, staffed by volunteers who care for the needs of the elderly travelers (Honor Flight Network 2011). Sociologists are interested in exploring the answers to questions such as these through three different perspectives: functionalism, symbolic interactionism, and conflict theory. Functionalists find that people with better resources who stay active in other roles adjust better to old age (Crosnoe and Elder 2002). Three social theories within the functional perspective were developed to explain how older people might deal with later-life experiences. First, because everyone expects to die one day, and because we experience physical and mental decline as we approach death, it is natural to withdraw from individuals and society. Second, as the elderly withdraw, they receive less reinforcement to conform to social norms. Finally, social withdrawal is gendered, meaning it is experienced differently by men and women. Because men focus on work and women focus on marriage and family, when they withdraw they will be unhappy and directionless until they adopt a role to replace their accustomed role that is compatible with the disengaged state (Cummings and Henry 1961). The suggestion that old age was a distinct state in the life course, characterized by a distinct change in roles and activities, was groundbreaking when it was first introduced. Criticisms typically focus on the application of the idea that seniors universally naturally withdraw from society as they age, and that it does not allow for a wide variation in the way people experience aging (Hothschild 1975). According to this theory, activity levels and social involvement are key to this process, and key to happiness (Havinghurst 1961; Neugarten 1964; Havinghurst, Neugarten, and Tobin 1968). According to this theory, the more active and involved an elderly person is, the happier he or she will be. Critics of this theory point out that access to social opportunities and activity are not equally available to all. Moreover, not everyone finds fulfillment in the presence of others or participation in activities. Reformulations of this theory suggest that participation in informal activities, such as hobbies, are what most effect later life satisfaction (Lemon, Bengtson, and Petersen 1972). According to continuity theory, the elderly make specific choices to maintain consistency in internal (personality structure, beliefs) and external structures (relationships), remaining active and involved throughout their elder years. This is an attempt to maintain social equilibrium and stability by making future decisions on the basis of already developed social roles (Atchley 1971; Atchley 1989). Making Connections: Sociology in the Real World the Graying of American Prisons Figure 13. A growing elderly prison population requires asking questions about how to deal with senior inmates. He has undergone two cataract surgeries and takes about $1,000 a month worth of medication to manage a heart condition. He needs significant help moving around, which he obtains by bribing younger inmates. He is serving a life prison term for a murder he committed thirty-eight years-half a lifetime-ago (Warren 2002). According to a recent report released by Human Rights Watch (2012), there are now more than 124,000 prisoners age fifty-five years or older and over 26,000 prisoners age sixty-five or older in the U. One is the tough-on-crime reforms of the 1980s and 1990s, when mandatory minimum sentencing and "three strikes" policies sent many people to jail for thirty years to life, even when the third strike was a relatively minor offense (Leadership Conference, n. As discussed in the section on aging in the United States, the percentage of people over sixty-five years old is increasing each year due to rising life expectancies and the aging of the baby boom generation. As discussed in the section on the process of aging, growing older is accompanied by a host of physical problems, like failing vision, mobility, and this OpenStax book is available for free at cnx. Chronic illnesses like heart disease, arthritis, and diabetes also become increasingly common as people age, whether they are in prison or not. In many cases, elderly prisoners are physically incapable of committing a violent-or possibly any-crime. There seem to be a lot of reasons, both financial and ethical, to release some elderly prisoners to live the rest of their lives-and die-in freedom. However, few lawmakers are willing to appear soft on crime by releasing convicted felons from prison, especially if their sentence was "life without parole" (Warren 2002). In advocating for themselves, they help shape public policy and alter the allotment of available resources. According to the guiding principle of conflict theory, social groups compete with other groups for power and scarce resources. In hard economic times, there is great concern about the huge costs of Social Security and Medicare. One of every four tax dollars, or about 28 percent, is spent on these two programs. While there is more care available to certain segments of the senior community, it must be noted that the financial resources available to the aging can vary tremendously by race, social class, and gender. Modernization theory (Cowgill and Holmes 1972) suggests that the primary cause of the elderly losing power and influence in society are the parallel forces of industrialization and modernization. As societies modernize, the status of elders decreases, and they are increasingly likely to experience social exclusion. Before industrialization, strong social norms bound the younger generation to care for the older. Societies become increasingly individualistic, and norms regarding the care of older people change. In an individualistic industrial society, caring for an elderly relative is seen as a voluntary obligation that may be ignored without fear of social censure. The central reasoning of modernization theory is that as long as the extended family is the standard family, as in preindustrial economies, elders will have a place in society and a clearly defined role. As societies modernize, the elderly, unable to work outside of the home, have less to offer economically and are seen as a burden. This model may be applied to both the developed and the developing world, and it suggests that as people age they will be abandoned and lose much of their familial support since they become a nonproductive economic burden. Another theory in the conflict perspective is age stratification theory (Riley, Johnson, and Foner 1972). Though it may seem obvious now, with our awareness of ageism, age stratification theorists were the first to suggest that members of society might be stratified by age, just as they are stratified by race, class, and gender. Because age serves as a basis of social control, different age groups will have varying access to social resources such as political and economic power. Within societies, behavioral age norms, including norms about roles and appropriate behavior, dictate what members of age cohorts may reasonably do. For example, it might be considered deviant for an elderly woman to wear a bikini because 294 Chapter 13 Aging and the Elderly it violates norms denying the sexuality of older females. These norms are specific to each age strata, developing from culturally based ideas about how people should "act their age. Age stratification theory has been criticized for its broadness and its inattention to other sources of stratification and how these might intersect with age. For example, one might argue that an older white male occupies a more powerful role, and is far less limited in his choices, compared to an older white female based on his historical access to political and economic power. Finally, exchange theory (Dowd 1975), a rational choice approach, suggests we experience an increased dependence as we age and must increasingly submit to the will of others because we have fewer ways of compelling others to submit to us. Indeed, inasmuch as relationships are based on mutual exchanges, as the elderly become less able to exchange resources, they will see their social circles diminish. In this model, the only means to avoid being discarded is to engage in resource management, like maintaining a large inheritance or participating in social exchange systems via child care. In fact, the theory may depend too much on the assumption that individuals are calculating. It is often criticized for affording too much emphasis to material exchange and devaluing nonmaterial assets such as love and friendship. This microanalytic perspective assumes that if people develop a sense of identity through their social interactions, their sense of self is dependent on those interactions. A woman whose main interactions with society make her feel old and unattractive may lose her sense of self. But a woman whose interactions make her feel valued and important will have a stronger sense of self and a happier life. Symbolic interactionists stress that the changes associated with old age, in and of themselves, have no inherent meaning. This theory suggests that elders will disengage from society and develop new patterns of interaction with peers who share common backgrounds and interests. Whether brought together by social or political interests, or even geographic regions, elders may find a strong sense of community with their new group. Another theory within the symbolic interaction perspective is selective optimization with compensation theory. Baltes and Baltes (1990) based their theory on the idea that successful personal development throughout the life course and subsequent mastery of the challenges associated with everyday life are based on the components of selection, optimization, and compensation. Though this happens at all stages in the life course, in the field of gerontology, researchers focus this OpenStax book is available for free at cnx. Here, aging is a process and not an outcome, and the goals (compensation) are specific to the individual. According to this theory, our energy diminishes as we age, and we select (selection) personal goals to get the most (optimize) for the effort we put into activities, in this way making up for (compensation) the loss of a wider range of goals and activities. In this theory, the physical decline postulated by disengagement theory may result in more dependence, but that is not necessarily negative, as it allows aging individuals to save their energy for the most meaningful activities. For example, a professor who values teaching sociology may participate in a phased retirement, never entirely giving up teaching, but acknowledging personal physical limitations that allow teaching only one or two classes per year. Swedish sociologist Lars Tornstam developed a symbolic interactionist theory called gerotranscendence: the idea that as people age, they transcend the limited views of life they held in earlier times. Tornstam believes that throughout the aging process, the elderly become less self-centered and feel more peaceful and connected to the natural world. Some elderly people might still grow bitter and isolated, feel ignored and left out, or become grumpy and judgmental. Symbolic interactionists believe that, just as in other phases of life, individuals must struggle to overcome their own failings and turn them into strengths. Aging in Society the social study of aging uses population data and cohorts to predict social concerns related to aging populations. In the United States, the population is increasingly older (called "the graying of the United States"), especially due to the baby boomer segment. Although medical technology has lengthened life expectancies, it cannot eradicate aging and death. Cultural attitudes shape the way our society views old age and dying, but these attitudes shift and evolve over time. Ageism, which involves stereotyping and discrimination against the elderly, leads to misconceptions about their abilities. Although elderly poverty has been improving for decades, many older people may be detrimentally affected by the 2008 recession. Some elderly people grow physically frail and, therefore, dependent on caregivers, which increases their risk of elder abuse. Theories in the functionalist perspective focus on the role of elders in terms of the functioning of society as a whole.
In practicing cultural relativism hair loss in men exercise propecia 1 mg on-line, we should also consider variations hair loss cure kidney discount 5 mg propecia, such as whether a legal union is required (think of "common law" marriage and its equivalents) hair loss 20 year old female generic propecia 1mg fast delivery, or whether more than two people can be involved (consider polygamy) hair loss wigs propecia 1 mg online. Other variations on the definition of marriage might include whether spouses are of opposite sexes or the same sex and how one of the traditional expectations of marriage (to produce children) is understood today hair loss talk forum buy propecia 5mg. Sociologists are interested in the relationship between the institution of marriage and the institution of family because hair loss baby order 5mg propecia with mastercard, historically hair loss pcos generic propecia 5 mg on line, marriages are what create a family hair loss 12 months postpartum buy 1mg propecia with amex, and families are the most basic social unit upon which society is built. A husband, a wife, and two children-maybe even a pet-has served as the model for the traditional U. But what about families that deviate from this model, such as a single-parent household or a homosexual couple without children The question of what constitutes a family is a prime area of debate in family sociology, as well as in politics and religion. Social conservatives tend to define the family in terms of structure with each family member filling a certain role (like father, mother, or child). Sociologists, on the other hand, tend to define family more in terms of the manner in which members relate to one another than on a strict configuration of status roles. Sociologists identify different types of families based on how one enters into them. Drawing on two sociological paradigms, the sociological understanding of what constitutes a family can be explained by symbolic interactionism as well as functionalism. These two theories indicate that families are groups in which participants view themselves as family members and act accordingly. In other words, families are groups in which people come together to form a strong primary group connection and maintain emotional ties to one another over a long period of time. In addition, the functionalist perspective views families as groups that perform vital roles for society-both internally (for the family itself) and externally (for society as a whole). While interactionism helps us understand the subjective experience of belonging to a "family," functionalism illuminates the many purposes of families and their roles in the maintenance of a balanced society (Parsons and Bales 1956). In a 2010 survey conducted by professors at the University of Indiana, nearly all participants (99. Ninety-two percent stated that a husband and a wife without children still constitute a family. The numbers drop for less traditional structures: unmarried couples with children (83 percent), unmarried couples without children (39. This survey revealed that children tend to be the key indicator in establishing "family" status: the percentage of individuals who agreed that unmarried couples and gay couples constitute a family nearly doubled when children were added. Census Bureau defines a family as "a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together" (U. While this structured definition can be used as a means to consistently track family-related patterns over several years, it excludes individuals such as cohabitating unmarried heterosexual and homosexual couples. Legality aside, sociologists would argue that the general concept of family is more diverse and less structured than in years past. Society has given more leeway to the design of a family making room for what works for its members (Jayson 2010). President Ronald Regan notably stated, "The family has always been the cornerstone of American society. Our families nurture, preserve, and pass on to each succeeding generation the values we share and cherish, values that are the foundation of our freedoms" (Lee 2009). While the design of the family may have changed in recent years, the fundamentals of emotional closeness and support are still present. Most responders to the Pew survey stated that their family today is at least as close (45 percent) or closer (40 percent) than the family with which they grew up (Pew Research Center 2010). Alongside the debate surrounding what constitutes a family is the question of what people in the United States believe constitutes a marriage. Many religious and social conservatives believe that marriage can only exist between a man and a woman, citing religious scripture and the basics of human reproduction as support. Social liberals and progressives, on the other hand, believe that marriage can exist between two consenting adults-be they a man and a woman, or a woman and a woman-and that it would be discriminatory to deny such a couple the civil, social, and economic benefits of marriage. Marriage Patterns With single parenting and cohabitation (when a couple shares a residence but not a marriage) becoming more acceptable in recent years, people may be less motivated to get married. In a recent survey, 39 percent of respondents answered "yes" when asked whether marriage is becoming obsolete (Pew Research Center 2010). The institution of marriage is likely to continue, but some previous patterns of marriage will become outdated as new patterns emerge. In this context, cohabitation contributes to the phenomenon of people getting married for the first time at a later age than was typical in earlier generations (Glezer 1991). Furthermore, marriage will continue to be delayed as more people place education and career ahead of "settling down. People in the United States typically equate marriage with monogamy, when someone is married to only one person at a time. In many countries and cultures around the world, however, having one spouse is not the only form of marriage. In a majority of cultures (78 percent), polygamy, or being married to more than one person at a time, is accepted (Murdock 1967), with most polygamous societies existing in northern Africa and east Asia (Altman and Ginat 1996). The reverse, when a woman is married to more than one man at the same time, is called polyandry. The reasons for the overwhelming prevalence of polygamous societies are varied but they often include issues of population growth, religious ideologies, and social status. While the majority of societies accept polygyny, the majority of people do not practice it. Negev Bedouin men in Israel, for example, typically have two wives, although it is acceptable to have up to four (Griver 2008). In the United States, polygamy is considered by most to be socially unacceptable and it is illegal. The act of entering into marriage while still married to another person is referred to as bigamy and is considered a felony in most states. Polygamy in the United States is often associated with those of the Mormon faith, although in 1890 the Mormon Church officially renounced polygamy. It is estimated that there are about 37,500 fundamentalist Mormons involved in polygamy in the United States, Canada, and Mexico, but that number has shown a steady decrease in the last 100 years (Useem 2007). Muslims, however, are an emerging group with an estimated 20,000 practicing polygamy. Muslims is uncommon and occurs only in approximately 1 percent of the population (Useem 2007). Sixty percent of societies, mostly modernized nations, follow a bilateral descent pattern. In partrilineal societies, such as those in rural China and India, only males carry on the family surname. This gives males the prestige of permanent family membership while females are seen as only temporary members (Harrell 2001). Matrilineal descent is common in Native American societies, notably the Crow and Cherokee tribes. In ambilineal societies, which are most common in Southeast Asian countries, parents may choose to associate their children with the kinship of either the mother or the father. Patrilocal residence is thought to be disadvantageous to women because it makes them outsiders in the home and community; it also keeps them disconnected from their own blood relatives. The Minangkabau people, a matrilocal society that is indigenous to the highlands of West Sumatra in Indonesia, believe that home is the place of women and they give men little power in issues relating to the home or family (Joseph and Najmabadi 2003). Most societies that use patrilocal and patrilineal systems are patriarchal, but very few societies that use matrilocal and matrilineal systems are matriarchal, as family life is often considered an important part of the culture for women, regardless of their power relative to men. Historically, it was often thought that many families evolved through a series of predictable stages. Developmental or "stage" theories used to play a prominent role in family sociology (Strong and DeVault 1992). Today, however, these models have been criticized for their linear and conventional assumptions as well as for their failure to capture the diversity of family forms. While reviewing some of these once-popular theories, it is important to identify their strengths and weaknesses. The set of predictable steps and patterns families experience over time is referred to as the family life cycle. One of the first designs of the family life cycle was developed by Paul Glick in 1955. Stage 1 2 3 4 5 6 7 Family Type Marriage Family Children Childless Procreation Family Children ages 0 to 2. Sociologists view each stage as having its own structure with different challenges, achievements, and accomplishments that transition the family from one stage to the next. For example, the problems and challenges that a family experiences in Stage 1 as a married couple with no children are likely much different than those experienced in Stage 5 as a married couple with teenagers. The success of a family can be measured by how well they adapt to these challenges and transition into each stage. While sociologists use the family life cycle to study the dynamics of family overtime, consumer and marketing researchers have used it to determine what goods and services families need as they progress through each stage (Murphy and Staples 1979). As early "stage" theories have been criticized for generalizing family life and not accounting for differences in gender, ethnicity, culture, and lifestyle, less rigid models of the family life cycle have been developed. One example is the family life course, which recognizes the events that occur in the lives of families but views them as parting terms of a fluid this OpenStax book is available for free at cnx. Making Connections: Sociology in the Real World the Evolution of Television Families Whether you grew up watching the Cleavers, the Waltons, the Huxtables, or the Simpsons, most of the iconic families you saw in television sitcoms included a father, a mother, and children cavorting under the same roof while comedy ensued. While some shows of this era portrayed single parents (My Three Sons and Bonanza, for instance), the single status almost always resulted from being widowed-not divorced or unwed. Still, traditional families such as those in Family Ties and the Cosby Show dominated the ratings. Shows such as Roseanne, Married with Children, and the Simpsons portrayed traditional nuclear families, but in a much less flattering light than those from the 1960s did (Museum of Broadcast Communications 2011). Over the past ten years, the nontraditional family has become somewhat of a tradition in television. While most situation comedies focus on single men and women without children, those that do portray families often stray from the classic structure: they include unmarried and divorced parents, adopted children, gay couples, and multigenerational households. Even those that do feature traditional family structures may show less-traditional characters in supporting roles, such as the brothers in the highly rated shows Everybody Loves Raymond and Two and Half Men. The show follows an extended family that includes a divorced and remarried father with one stepchild, and his biological adult children-one of who is in a traditional two-parent household, and the other who is a gay man in a committed relationship raising an adopted daughter. According to 2010 census data, only 66 percent of children under seventeen years old live in a household with two married parents. This two-parent family structure is known as a nuclear family, referring to married parents and children as the nucleus, or core, of the group. Recent years have seen a rise in variations of the nuclear family with the parents not being married. In 2010, 27 percent of children lived with a single parent only, up from 25 percent in 2008. Of that 27 percent, 23 percent live with their mother and three percent live with their father. Ten percent of children living with their single mother and 20 percent of children living with their single father also live with the cohabitating partner of their parent (for example, boyfriends or girlfriends). Among children living in two-parent households, 9 percent live with a biological or adoptive parent and a stepparent. The majority (70 percent) of those children live with their biological mother and a stepfather. Older children (fifteen to seventeen years old) are less likely to live with two parents than adolescent children (six to fourteen years old) or young children (zero to five years old). Older children who do live with two parents are also more likely to live with stepparents (U. In 2010, three million children (4 percent of all children) lived with a guardian who was neither their biological nor adoptive parent. Of these children, 54 percent live with grandparents, 21 percent live with other relatives, and 24 percent live with nonrelatives. This family structure is referred to as the extended family, and may include aunts, uncles, and cousins living in the same home. Nine percent of all children live with a grandparent, and in nearly half those cases, the grandparent maintains primary responsibility for the child (U. A grandparent functioning as the primary care provider often results from parental drug abuse, incarceration, or abandonment. Changes in the traditional family structure raise questions about how such societal shifts affect children. Census statistics have long shown that children living in homes with both parents grow up with more financial and educational advantages than children who are raised in single-parent homes (U. Children living with a divorced parent typically have more advantages than children living with a parent who never married; this is particularly true of children who live with divorced fathers. This correlates with the statistic that never-married parents are typically younger, have fewer years of schooling, and have lower incomes (U. Six in ten children living with only their mother live near or below the poverty level. Of those being raised by single mothers, 69 percent live in or near poverty compared to 45 percent for divorced mothers (U. Though other factors such as age and education play a role in these differences, it can be inferred that marriage between parents is generally beneficial for children. Cohabitation Living together before or in lieu of marriage is a growing option for many couples. Cohabitation, when a man and woman live together in a sexual relationship without being married, was practiced by an estimated 7. This surge in cohabitation is likely due to the decrease in social stigma pertaining to the practice. In a 2010 National Center for Health Statistics survey, only 38 percent of the 13,000-person sample thought that cohabitation negatively impacted society this OpenStax book is available for free at cnx. Cohabitating couples may choose to live together in an effort to spend more time together or to save money on living costs. Today, approximately 28 percent of men and women cohabitated before their first marriage. By comparison, 18 percent of men and 23 percent of women married without ever cohabitating (U. The vast majority of cohabitating relationships eventually result in marriage; only 15 percent of men and women cohabitate only and do not marry. While couples may use this time to "work out the kinks" of a relationship before they wed, the most recent research has found that cohabitation has little effect on the success of a marriage. In fact, those who do not cohabitate before marriage have slightly better rates of remaining married for more than ten years (Jayson 2010). Cohabitation may contribute to the increase in the number of men and women who delay marriage. Census Bureau, 2000 Census and American Community Survey) Same-Sex Couples the number of same-sex couples has grown significantly in the past decade. Census Bureau reported 594,000 same-sex couple households in the United States, a 50 percent increase from 2000. This increase is a result of more coupling, the growing social acceptance of homosexuality, and a subsequent increase in willingness to report it. Nationally, same-sex couple households make up 1 percent of the population, ranging from as little as 0. Legal recognition of same-sex couples as spouses is different in each state, as only six states and the District of Columbia have legalized same-sex marriage. Census, however, allowed same-sex couples to report as spouses regardless of whether their state legally recognizes their relationship. Nationally, 25 percent of all same-sex households reported that they were spouses. In terms of demographics, same-sex couples are not very different from opposite-sex couples. Same-sex couple households have an average age of 52 and an average household income of $91,558; opposite-sex couple households have an average age of 59 and an average household income of $95,075. Additionally, 31 percent of same-sex couples are raising children, not far from the 43 percent of opposite-sex couples (U. Of the children in same-sex couple households, 73 percent are biological children (of only one of the parents), 21 percent are adopted only, and 6 percent are a combination of biological and adopted (U. While there is some concern from socially conservative groups regarding the well-being of children who grow up in samesex households, research reports that same-sex parents are as effective as opposite-sex parents. In an analysis of 81 parenting studies, sociologists found no quantifiable data to support the notion that opposite-sex parenting is any better than same-sex parenting. Children of lesbian couples, however, were shown to have slightly lower rates of behavioral problems and higher rates of self-esteem (Biblarz and Stacey 2010). Staying Single Gay or straight, a new option for many people in the United States is simply to stay single. In 2010, never-married individuals in the twenty-five to twenty-nine age bracket 316 Chapter 14 Marriage and Family accounted for 62 percent of women and 48 percent of men, up from 11 percent and 19 percent, respectively, in 1970 (U. Single, or never-married, individuals are found in higher concentrations in large cities or metropolitan areas, with New York City being one of the highest. Although both single men and single women report social pressure to get married, women are subject to greater scrutiny. Single women are often portrayed as unhappy "spinsters" or "old maids" who cannot find a man to marry them. Single men, on the other hand, are typically portrayed as lifetime bachelors who cannot settle down or simply "have not found the right girl.
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