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Recreational drugs. Societal and professional issues.

Recreational drug use presents a challenge to society and, in particular, the profession of nursing. Recreational drug use must be appreciated for the implications it presents for the episodes of abuse and development of chronic health problems. The effects and recreational use of volatile substances, cannabis, opioids, barbiturates, benzodiazepines, amphetamines, cocaine, psychedelics, and designer drugs as well as alcohol, caffeine, and nicotine must be acknowledged and understood if options for change are to be considered. The resultant cost of recreational drug use as well as health care implications, public safety, and prevention are significant issues society is faced with today. These issues will continue to be significant unless the current posture toward recreational drug use and abuse is addressed. The profession of nursing continues to be faced with the problems associated with recreational drug use not only through caring for clients, but immediately by the effects of recreational drug use on individual professional nurses. To respond effectively, nursing education and nursing research must be challenged to create an emphasis on this focus. Only through this type of multifocal approach will long-term substantial change be affected for the betterment of future generations.

Adolescent

Effect of occupational and recreational activity on the risk of colorectal cancer among males: a case-control study.

Epidemiological studies have consistently demonstrated that either occupational or recreational physical activity is protective against colon cancer. However, it is unclear whether recreational activity is similarly protective among those who engage in high or low occupational activity. We therefore compared 440 male cases of colorectal cancer with 1164 male hospital patients. Occupational activity was defined according to job title, while recreational activity was assessed by questionnaire for three different periods of life. Occupational activity was protective with respect to colorectal cancer irrespective of whether one engaged in recreational activity at any different period of life. In contrast, recreational activity, performed at 20-44 years of age appeared to decrease colon cancer risk by 10-25% irrespective of the intensity of job activity. The present results suggest that, although we observed a larger effect with occupational activity than with recreational activity, middle-aged men may reduce their risk of colorectal cancer if they exercise when they are not working. These findings need to be confirmed in other populations.

Adolescent

Youth's recreation and drug sensations: is there a relationship?

Adolescents' social behaviors remain a mystery to parks and recreation providers. Adolescence is a "high-risk" time for all youth in terms of experimenting with potentially health-compromising behavior, whether alcohol, drugs, or sex. Most of these antisocial behaviors occur during adolescents' leisure time. These inferences gave impetus to this research effort. The study was designed to ascertain information on adolescents' preferences for pleasure: drugs or recreation. Data were collected from a sample of 100 high school students from a medium-sized college town, and 100 students from a rural town in Florida. Findings revealed four statistically significant associations in the motives or pleasures sought in recreation and in drug behaviors: "enhancement of popularity," "provision of a means for self-discovery," "achievement of personal goal," and means to rebel against parents. In reference to the latter motive, findings revealed that neither drugs nor recreation were used to rebel against parents. Findings also provide documentation of the value of recreation in insulating adolescents against many of the stressors of contemporary life.

Adolescent

Intravascular haemolysis in the recreational runner.

Intravascular haemolysis has been found to result from prolonged endurance competition, rigorous military training and participation in impact sports. Haematological research involving the recreational runner is sparse. Recreational runners frequently vary their training to avoid monotony and improve endurance capacity. This study investigated the haematological effects of a typical day of increased distance training in 15 male recreational runners (62.4(3.1) ml kg-1 min-1 treadmill VO2max; 44.6(8.4) km per week training (means(s.d.)). Venous blood samples were collected before, immediately after, 1 day, 4 days, and 10 days after a 13-km training run (about twice the subjects' typical running distance) and analysed for changes in bilirubin, serum potassium, haematocrit, haemoglobin, red blood cell count, haptoglobin, poikilocytosis and reticulocytosis. Urine samples were collected at the same times as the blood samples and analysed for urobilinogen. Significant (P less than 0.05) 1-day and 4-day decreases in mean haemoglobin, red blood cell count, and haptoglobin values, compared to before training venous blood values and significant (P less than 0.05) post-training increases in bilirubin, serum potassium, urobilinogen and poikilocytosis provided evidence for increased intravascular haemolysis. After 10 days the values for haematocrit, bilirubin, serum potassium, red blood cell count, urobilinogen and poikilocytosis were not significantly (P less than 0.05) different from pre-training values while haemoglobin remained significantly (P less than 0.05) lower, exhibiting a constant but not significant increase over the period from 1 to 10 days. The results indicate that mild intravascular 'footstrike' haemolysis can occur in the recreational runner when typical training distance is increased. This condition appears to be transient and benign.

Anemia

Motivational effects of smoked marijuana: behavioral contingencies and high-probability recreational activities.

Fifteen adult male research volunteers, in five groups of three subjects each, lived in a residential laboratory for up to 20 days. All contact with the experimenters was through a networked computer system, and subjects' behaviors were monitored continuously and recorded. During the first part of each day, subjects remained in their private rooms doing planned work activities, and during the remainder of each day, they were allowed to socialize. One or two cigarettes containing active marijuana (1.3-2.7% delta 9-THC) or placebo were smoked during both the private work period and the period of access to social activities. Two-or three-day contingency conditions requiring subjects to engage in a low-probability recreational activity in order to earn time that could be spent engaging in a high-probability recreational activity were programmed during periods of placebo and active marijuana smoking. During placebo administration, the contingency requirement reliably increased the amount of time that subjects spent engaged in the low-probability instrumental activity and decreased the time spent engaged in the high-probability contingent activity. During active marijuana administration, however, the increases in instrumental activity were consistently smaller than observed under placebo conditions. The decreases in high-probability contingent activity were similar across drug conditions. Smoking active marijuana was thus observed to produce instrumental decrements under motivational conditions involving recreational contingencies.

Adult

The influence of cadence and power output on the biomechanics of force application during steady-rate cycling in competitive and recreational cyclists.

The intent of this study was two-fold. The first aim was to investigate how cyclists orient forces applied by the feet to the pedals in response to varying power output and cadence demands, and the second was to assess whether competitive riders responded differently from recreational riders to such variations. One group consisted of US Cycling Federation category II licensed competitive cyclists (n = 7) and the second group consisted of recreational cyclists with no competitive experience (n = 38). The subjects rode an instrumented stationary 10-speed geared bicycle mounted on a platform designed to provide rolling and inertial resistance for six pedal rate/power output conditions for a minimum of 2 min for each ride. The pedalling rates were 60, 80 and 100 rev min-1 and the power outputs 100 and 235 W. All rides were presented in random order. The forces applied to the pedals, the pedal angle with respect to the crank and the crank angle were recorded for the final 30 s of each ride. From these data, a number of variables were computed including peak normal and tangential forces, crank torque, angular impulse, proportion of resultant force perpendicular to the crank, and pedal angle. Both the competitive and recreational groups responded similarly to increases in cadence and power output. There was a decrease in the peak normal forces, whereas the tangential component remained almost constant as cadence was increased. Regardless of cadence, the riders responded to increased power output demands by increasing the amount of positive angular impulse. All the riders had a reduced index of effectiveness as cadence increased. This was found to be the result of the large effect of the forces during recovery on this calculation. There were no significant differences between the two groups in each of these variables over all conditions. It was concluded that the lack of difference between the groups was a combined consequence of the limited degrees of freedom associated with the bicycle and that the relatively low power output for the competitive riders was insufficient to discriminate or highlight superior riding technique.

Adolescent

A three-phase analysis of the prevention of recreational softball injuries.

Recreational sports injuries are expensive to society. Prevention of such injuries must be a major public health goal. In a previous retrospective study, base sliding was found to be responsible for 71% of recreational softball injuries. Because most injuries occurred during rapid deceleration against stationary bases, quick-release (break-away) bases were evaluated as a means to modify this mechanism of injury. In a prospective study, 633 softball games were played on a break-away base fields and 627 games were played on stationary base fields. Forty-five sliding injuries occurred on the stationary base diamonds (1 injury for every 13.9 games) and only two sliding injuries occurred on the break-away fields (1 injury for every 316.5 games). The medical costs for injuries on the stationary base fields was 79 times greater than that on the break-away fields. In a 1035 game follow-up study performed on all fields equipped with break-away bases, two sliding injuries occurred (1 injury for every 517.5 games). Installing break-away bases in fields used by recreational leagues would achieve a significant reduction of serious softball injuries (98%) and, therefore, should be mandatory. Based on our findings, the Centers for Disease Control has estimated 1.7 million injuries would be prevented nationally per year, saving $2.0 billion per year nationally in acute medical care costs.

Adolescent

[A study on the physical effects of short-time recreation activities at a hot spring resort on unhealthy middle-aged workers].

A pilot study to improve unhealthy life habits of thirty middle-aged male clerical workers (45 +/- 3.58 yr.) with mild health disorders such as hypertension, hypercholesterolemia, diabetes mellitus and fatty liver was carried out. Under prohibition of smoking and alcohol intake, they spent five nights and six days at a hot spring resort, taking part in planned health training programs which included aerobic training, hiking in forests, hot spring baths, cooking practice and lectures about healthy life, controlled by medical, dietary and physical training staffs. To evaluate the short-term effects of these activities, body weight, blood pressure, serum lipid (total cholesterol, high-density-lipoprotein cholesterol, triglyceride, total free fatty acid and phospholipid), blood sugar, uric acid, gamma-glutamyl transpeptidase (gamma-GTP) and glutamic-oxaloacetic transaminase (GOT) were examined early in the morning of the second (before) and the fifth (after) days, and then their impressions of these recreation activities were monitored by questionnaires on the sixth day. By t-tests of all before-and-after data, it was shown that mean values of body weight, systolic blood pressure, high-density-lipoprotein cholesterol, triglyceride, phospholipid and gamma-GTP were improved, but fasting blood sugar, uric acid and GOT were not improved. In comparison of blood pressure levels, the hypertensive group (n = 9) showed lowering in both systolic and diastolic blood pressure, though the normal group (n = 10) had slight elevation. In addition, in the hypercholesterolemic group (n = 11, greater than or equal to 220 mg/dl) mean total cholesterol values decreased, conversely in the hypocholesterolemic group (n = 6, less than 180 mg/dl) they increased. Moreover, the obese group (n = 15, obesity index greater than or equal to 120%) showed greater decreases of body weight, triglyceride and phospholipid than the non-obese group. From questionnaires, it was confirmed that through these recreation activities most participants found mental and spiritual satisfaction, in spite of heavy physical loads. The short-term recreation activities under a stressless environment seemed to maintain the function of homeostasis in the body, but further investigation is needed to examine the relation between the contents of diets and physical activities, and to follow the long-term effects on the participants.

Adult

Health effects of recreational running in women. Some epidemiological and preventive aspects.

Estimated maximum oxygen uptake of middle-aged nonelite road race entrants is around 45 to 50 ml/kg/min, which is 40 to 100% higher than values from the female general population. Endurance training, low bodyweight, and nonsmoking of runners explain part of, but not the whole, difference in aerobic capacity observed between athletes and the general population. Sedentary women can improve cardiorespiratory fitness through aerobic exercise programmes, and the women with the lowest level of initial fitness have the highest proportional improvement following training. Regularly exercising women have a significantly reduced risk of fatal and nonfatal coronary events, and low cardiorespiratory fitness is associated with an increased risk of death and nonfatal stroke. The influence of habitual running on the female blood lipid profile is not clear. Cross-sectional studies have found elevated HDL cholesterol concentrations in distance runners, but intervention studies on the effect of jogging on lipid and lipoprotein levels have provided equivocal results. A higher level of physical fitness is associated with a lower risk to subsequently develop hypertension. Experimental studies have shown that moderate intensity aerobic exercise (40 to 60% VO2max) is able to reduce blood pressure significantly in hypertensive subjects. An athletic lifestyle may be associated with a reduced risk of adult-onset diabetes mellitus (via an exercise-induced increase in insulin-sensitivity), and with a reduced risk of cancers of the reproductive system, breast, and colon. Recreational running is also correlated with better weight control. Surveys of recreational and elite distance runners show a great variability in the prevalence of secondary amenorrhoea, between 1 and 44%. Environmental factors determining the risk of amenorrhoea in runners are low body fat content, mileage, and nutritional inadequacy, with low intakes of calories, protein, and fat. Amenorrhoeic athletes in their third and fourth decade have lower vertebral bone density, which is improved after resumption of menses but does not completely reach age-specific average values. Regardless of menstrual status, the effectiveness of exercise to maintain bone mass throughout life is an important issue. Habitual exercise is associated with increased bone density of the spine both in premenopausal and postmenopausal women. Several controlled training studies suggest that postmenopausal women may at least retard their bone loss with regular aerobic exercise. Running-related injuries and complaints are common in recreational joggers, even though the reported 1-year incidence, varying between 14 and approximately 50%, depends on injury definition. Mileage and a history of previous running injury are known risk factors.(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiovascular Diseases

[Recreation as one of the trends in human ecology].

The significance of the recreation complex of branches of recreation sciences--in the development of human ecology is examined. Much attention is payed to the problems of human interaction with environment, to the analysis of specific qualities of arising integral socio-political formations--recreation systems, and to the questions of human adaptation to different qualities of natural and social geosystems.

Ecology

Recreational drug use and sexual behavior change in a cohort of homosexual men. The Multicenter AIDS Cohort Study (MACS).

The relationship between use of recreational drugs and high-risk (HIV-transmitting) homosexual behavior was examined in the Multicenter AIDS Cohort Study (MACS) population. Among the 3916 men who completed both the baseline (1984) and first 6-month follow-up evaluations and were sexually active during the 6 months prior to enrollment, self-reported use of each of 10 classes of recreational drugs in conjunction with sexual activity was analyzed for both cross-sectional and prospective relationships with pattern of sexual behavior using a four-level sexual risk behavior index. At baseline, the proportion of men in the highest risk category (unprotected anal exposures with multiple partners) increased from 36 to 85% when men not using any drugs to men using three or more drugs plus volatile nitrites were examined. In multivariate logistical analyses, volatile nitrite use was significantly associated with failure to maintain or attain lower sexual risk levels after controlling for the effects of age, educational level and numbers of high-risk partners. These results suggest that volatile nitrite use may play an important role in the association between recreational drug use and high-risk sexual behavior among homosexual/bisexual men.

Acquired Immunodeficiency Syndrome

Recreational MDMA use in Sydney: a profile of 'Ecstacy' users and their experiences with the drug.

'Ecstasy' (3,4-methylenedioxymethamphetamine or MDMA) is a recreational drug that is gaining popularity world wide. There is a paucity of research regarding the ways in which Ecstasy is used and the nature of its effects. A 'snowball' peer network technique was used to recruit 100 users who completed anonymous questionnaires. The research revealed that Ecstasy is primarily used by infrequent recreational drug users for 'fun' at dance parties and social gatherings. The primary reported effects of Ecstasy were a 'positive mood state' and feelings of intimacy and closeness to others. The secondary effects of Ecstasy were the stimulant effects of energy and activation, and the psychedelic effects of insight and perceptual and sensual enhancement. Ecstasy was reported to share the properties of both amphetamines and hallucinogens in the nature of its side effects and residual effects which were no more severe than those of the latter two classes of drug. It appeared Ecstasy was not conductive to regular and frequent use, because tolerance was reported to develop to the positive effects of Ecstasy, while negative effects increased with use. Although few problems associated with the recreational use of Ecstasy have surfaced to date, animal research has shown it to be neurotoxic to serotonergic nerve terminals. Caution must be observed until further research can determine the level of hazard in humans.

3,4-Methylenedioxyamphetamine

Cardiovascular effects of recreational cocaine abuse.

Deaths related to the recreational use of cocaine in the United States have increased to epidemic proportions within the last decade. Frequently, persons with cocaine toxicity present to the emergency room, require critical care nursing, and are admitted to the intensive care unit. This article outlines the cardiovascular effects of recreational cocaine abuse. Initially, the historical perspective of the drug is outlined. The mechanism of action, administration, absorption, and excretion are discussed. Details regarding the cardiovascular effects of cocaine are described. Although no uniform treatment plan has been developed for every complication of cocaine overdose, the current therapeutic modalities are outlined. Finally, the clinical implications for clinical practice are addressed. The recreational abuse of cocaine presents new patient care challenges for the critical care nurse. With increased knowledge, the health care provider may assist in meeting the clinical needs of this emerging patient population.

Cardiovascular System

Scombroid fish poisoning. Underreporting and prevention among noncommercial recreational fishers.

Food-borne diseases, including those caused by seafood products, are common and greatly underreported sources of morbidity. In this article we review the epidemiology of scombroid fish poisoning and its possible relationship to the noncommercial and recreational catch and sale of fish. More than 20% of all fish sold in the United States is caught by sport fishers, and outbreaks of scombroid fish poisoning have involved improperly handled fish from private catches. We report an outbreak of scombroid fish poisoning among recreational fishers in California. The unregulated sale of recreationally caught fish for consumption and the prevention of scombrotoxism are discussed from the perspectives of public health agencies, clinicians, and the fishing public. Scientific and policy issues that require further attention are high-lighted.

Adult

Asphyxial deaths from the recreational use of nitrous oxide.

The recreational use of nitrous oxide is widespread. Nitrous oxide for recreational use is usually obtained from anesthesia tanks or whipped-cream machine chargers or cans. Twenty previously described deaths associated with recreational nitrous-oxide use describe anesthesia tanks and whipped-cream machine dispensors as a source. Five deaths associated with nitrous oxide use are presented; two involving whipped-cream cannisters as the source, two involving anesthesia tanks, and one involving a racing fuel tank as a source of nitrous oxide. Autopsy findings in our cases were subtle or negative, but usually suggestive of asphyxia. Through a laboratory simulation, we have confirmed that nitrous oxide displaces oxygen in a closed space, which probably leads to asphyxia. A review of the literature, neuropharmacology, and pathophysiology of nitrous oxide use is also presented.

Adolescent

The VO2max of recreational athletes before and after pregnancy.

This study was designed to test the hypothesis that pregnancy has an added training effect (increases "absolute" VO2max) in well-conditioned, recreational athletes. VO2max was measured serially in 20 nonpregnant recreational athletes who maintained their exercise within +/- 10% of initial levels over a 15-month period and 20 similar women who conceived and continued exercise at a reduced level during pregnancy with a return to within 20% of initial levels by 12 wk postpartum. Initially the two groups were similar in terms of age (30 +/- 1 vs 30 +/- 2 yr), weight 57.6 +/- 7.2 vs 59.7 +/- 7.5 kg), max pulse rate (189 +/- 8 vs 187 +/- 10 bpm), and absolute (3083 +/- 469 vs 3138 +/- 464 ml.min-1) VO2max. In the nonpregnant group the values obtained 15 months later were unchanged (weight = 57.8 +/- 6.6 kg, max pulse = 191 +/- 7 bpm, VO2max = 2977 +/- 397 ml.min-1) while those who conceived had a significant increase in absolute VO2max that was evident 12-20 wk postpartum and was maintained at the time of final testing 36-44 wk postpartum (3368 +/- 435 ml.min-1). Both weight (60.1 +/- 8.1 kg) and maximum pulse rate (185 +/- 12 bpm) were unchanged. These data indicate that pregnancy is followed by a small but significant increase in VO2max in recreational athletes who maintain a moderate to high level of exercise performance during and after pregnancy.

Adult