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By I. Konrad. Northeastern Illinois University.

A typical study in 1993 differences obviously influence age-specific preva- showed that 8% of those with back pain (or 3% of the lence studies buy trental 400mg amex. In this period cheap 400 mg trental overnight delivery, 6% lost at least 1 day off age groups, but chronic pain increases with age (up work, with 1% off work for the entire 4-week period. Several painful conditions In a year, 8–20% of the population will have some which are more likely to occur in older people time off due to back pain. About half of the are relatively uncommon, and so tend to be underesti- lost working days are in short spells (averaging 6 days) mated in general surveys. The is joint pains and this reflects an increasing pathologi- longer a person is off work with back pain, the less cal load with advancing age. However, several pain Studies on risk factors for back pain have shown that syndromes actually decrease in frequency with age there is little difference between men and women. Work loss due to low back pain is commoner in lower social classes; how- ever, this may be related to manual work. Heavy man- Back pain ual work and perhaps driving and jobs involving exposure to whole body vibration, are risk factors for Back pain is a description rather than a diagnosis. There is an increased aetiology of back pain remains illusive, although it is prevalence of low back pain in smokers. What is clear is that it is common and that it causes Pain caused by cancer much disability and work loss. The estimated days of work loss caused by back pain in Britain in 1993 was Cancer is not a single disease and the prevalence of 52 million days, at a cost to the National Health pain varies widely between different types of cancer. Cancer causes pain by various mechanisms, including Most people will experience back pain at some time in involvement of bone, viscera or nerves. Studies show a point prevalence of 14–30%, prevalent in later stages of the disease and may be with a period prevalence over a year of about 40%. Lifetime lem is compounded by the fact that treatment may prevalence for sciatica is around 3–5%. It however is a ‘soft’ measure; disability and work loss is clear then that in any individual patient, whether being more reliable measures, with more utility. A study of all stages of the Cluster headache by contrast is rare, and five times disease in a cancer hospital found a prevalence of more common in males than females.

CONSIDERATION OF ETHNIC DIVERSITY ISSUES In some sense cheap trental 400mg without a prescription, all of our clients have a different background from ours buy trental 400mg otc, even if they were reared in the same country, state, and neighborhood. Ethnic background is one of the important determinants of personality and behavior. It deserves the same kind of at- tention that other factors require if we are to work sensitively and effec- tively with human beings. What are the general values and expected behaviors held by those in their group and its culture? The areas of couple interaction—the "Cs"—tend to be present for much of humankind but are colored by the values, beliefs, and behaviors peculiar to one’s social and cultural group. Essentially, working with marital couples appears to be done most effec- tively when we acquire information about marriage and family development in their ethnic settings from the study of general values and expected roles within their ethnic group. One of the best general sources for learning about ethnicity and marital and family therapy in North America is McGoldrick, Giordano, and Pearce’s (1996) edited work, Ethnicity and Family Therapy. Ex- cellent material for understanding and working with new American families who have come to the United States from India, Hispanic countries, Russia, Taiwan, northwestern Europe, and southwest Asia (Hmong families) ap- pears in Gates et al. More general sources consist of scattered articles in therapy journals and work in cultural anthropology and family sociology. Such materials form a useful background, but also need to be accompa- nied by a genuine respect for the clients and a willingness to ask them to explain to us what marriage and marital behaviors are expected in their families and ethnic group. A frank acknowledgment about what we do not understand and need to comprehend and the genuine request by the thera- pist to "help me understand" are the sine qua non for such work. SUMMARY This chapter summarizes the nature of marriage, cohabitation, and commit- ment, noting research that distinguishes between the different, stronger commitment that seems to prevail in marriages versus cohabitation. A brief description of American mate selection, marital life cycle, five tasks of mari- tal couples focused on early marriages, ethnic diversity issues, and some clinical illustrations are given. The relationship between cohabitation and divorce: Selectivity or causal influence? Commitment and the modern union: Assessing the link between premarital cohabitation and subsequent marital stability. First marriage dissolution, divorce, and re- marriage: United States (Advanced data from vital and health statistics, no.