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By N. Leif. Pikeville College.
However diflucan 150 mg visa fungus gnats uc davis, perhaps these different theories can also be used themselves as data to show how psychologists have thought in the past and how they now think about individuals. For example, in the past pain was seen as a passive response to external stimuli; therefore, individuals were seen as passive responders. However, today pain is increasingly seen as a response to the individual’s self-control – pain is a sign of either successful or failed self-control. Therefore, contemporary individuals are seen as having self-control, self-management and self-mastery. Perhaps the different theories over time reflect different (not necessarily better) versions of individuality. This book provides a comprehensive and critical overview of the complex area of pain assessment. This edited collection provides a detailed account of contemporary approaches to treating pain. This edited collection provides an excellent overview of how pain can be measured and the problems inherent within pain assessment. This paper examines how theories of pain perception can be used to reduce the pain experience. This chapter examines problems with defining placebos and then assesses the different theories concerning how they work, highlighting the central role for patient expectations. It then outlines the implications of placebos for the different areas of health psychology discussed in the rest of this book, such as health beliefs and illness cognitions, health behaviours, stress, pain and illness and places this within a discussion of the relationship between the mind and body and the interrelationship between beliefs, behaviour and health and illness. Placebos have been defined as follows: s Inert substances which cause symptom relief (e. For example, ‘My head- aches went after the operation, is this an unreal effect (it wasn’t predicted) or a real effect (it definitely happened)? For example, ‘I specifically went for cognitive restructuring therapy and ended up simply feeling less tired. For example, medicines such as wild animal faeces and the blood of a gladiator were supposed to increase strength, and part of a dolphin’s penis was supposed to increase virility. These so-called ‘medicines’ have been used at different times in different cultures but have no apparent medical (active) properties. In addition, treatments such as bleeding by leeches to decrease fever or travelling to religious sites such as Lourdes in order to alleviate symptoms have also continued across the years without any obvious understanding of the processes involved. Faith healers are another example of inert treatments ranging from Jesus Christ, Buddha and Krishna. The tradition of faith healers has persisted, although our understanding of the processes involved is very poor. Such apparently inert interventions, and the traditions involved with these practices, have lasted over many centuries. In addition, the people involved in these practices have become famous and have gained a degree of credibility. Perhaps, the maintenance of faith both in these interven- tions and in the people carrying out the treatments suggests that they were actually successful, giving the treatments themselves some validity. It is possible that there are medically active substances in some of these traditional treatments that were not understood in the past and are still not understood now (e. It is also possible that the effectiveness of some of these treatments can be understood in terms of modern-day placebo effects. Modern-day placebos Recently placebos have been studied more specifically and have been found to have a multitude of effects. For example, placebos have been found to increase performance on a cognitive task (Ross and Buckalew 1983), to be effective in reducing anxiety (Down- ing and Rickles 1983), and Haas et al. Beecher (1955), in an early study of the specific effects of placebos in pain reduction, suggested that 30 per cent of chronic pain sufferers show relief from a placebo when using both subjective (e. They reported that half the subjects with angina pain were given a sham operation, and half of the subjects were given a real heart bypass operation. The results indicated that pain reduction in both groups was equal, and the authors concluded that the belief that the individual had had an operation was sufficient to cause pain reduction and alleviation of the angina. Since the 1940s, research into the effectiveness of drugs has used randomized controlled trials and placebos to assess the real effects of a drug versus the unreal effects.
Social predictors of alcohol initiation and maintenance Many of the social factors that relate to smoking behaviour are also predictive of alcohol consumption order diflucan 200 mg free shipping fungus ergot. According to a disease model of addictions it could be argued that this reflects the genetic predisposition to develop an addictive behaviour. However, parental drinking may be influential through ‘social hereditary factors’, with children being exposed to drinking behaviour and learning this behaviour from their parents (Orford and Velleman 1991). In addition, peer group alcohol use and abuse also predicts drinking behaviour as does being someone who is sensation seeking, with a tendency to be aggressive and having a history of getting into trouble with authority. Johnston and White (2003) used the theory of planned behaviour (see Chapter 2) to predict binge drinking in students. However, given the social nature of binge drinking they focused on the role of norms. Using a longitudinal design, 289 undergraduate students completed a questionnaire concerning their beliefs with follow-up collected about reported binge drinking. The results showed an important role for norms particularly if the norms were of a behaviourally relevant reference group that the student reported a strong identification with. Cessation of an addictive behaviour can be examined in terms of the processes involved in cessation and the interventions designed to motivate individuals to quit their behaviour. The process of cessation Traditionally, smoking cessation was viewed as a dichotomy: an individual either smoked or did not. This perspective was in line with a biomedical model of addictions and emphasized the ‘all or nothing nature’ of smoking behaviour. However, early attempts at promoting total abstinence were relatively unsuccessful and research now often emphasizes cessation as a process. In particular, Prochaska and DiClemente (1984; see Chapter 2) adapted their stages of change model to examine cessation of addictive behaviours. They argued that cessation involves a shift across five basic stages: 1 precontemplation: defined as not seriously considering quitting; 2 contemplation: having some thoughts about quitting; 3 preparation: seriously considering quitting; 4 action: initial behaviour change; 5 maintenance: maintaining behaviour change for a period of time. Prochaska and DiClemente maintain that individuals do not progress through these stages in a straightforward and linear fashion but may switch backwards and forwards (e. They call this ‘the revolving door’ schema and emphasize the dynamic nature of cessa- tion. This model of change has been tested to provide evidence for the different stages for smokers and outpatient alcoholics (DiClemente and Prochaska 1982; 1985; DiClemente and Hughes 1990), and for the relationship between stage of change for smoking cessa- tion and self-efficacy (DiClemente 1986). The authors categorized smokers into either precontemplators or contemplators and examined their smoking behaviour at follow-up. They further classified the contemplators into either contemplators (those who were smoking, seriously considering quitting within the next six months, but not within the next 30 days) or those in the preparation stage (those who were seriously considering quitting smoking within the next 30 days). The results showed that those in the prepara- tion stage of change were more likely to have made a quit attempt at both one and six months, that they had made more quit attempts, and were more likely to be not smoking at the follow-ups. Research has also used the health beliefs and structured models outlined in Chapter 2 to examine the predictors of both intentions to stop smoking and successful smoking cessation. For example, individual cognitions such as perceptions of susceptibility, past cessation attempts and perceived behavioural control have been shown to relate to reductions in smoking behaviour (Giannetti et al. The results showed that the best predictors of intentions to quit were perceived behavioural control (i. At follow-up, the best predictors of making a quit attempt were intentions at baseline (i. However, DiClemente and Prochaska (1982) developed their transtheoretical model of change to examine the stages of change in addictive behaviours. This study examined the validity of the stages of change model and assessed the relationship between stage of change and smoking cessation. Background The original stages of change model describes the following stages: s Precontemplation: not seriously considering quitting in the next six months. The model is described as dynamic, not linear with individuals moving backwards and forwards across the stages. In this study, the authors categorized those in the con- templation stage as either contemplators (not considering quitting in the next 30 days) and those in the preparation stage (planning to quit in the next 30 days). Methodology Subjects A total of 1466 subjects were recruited for a minimum intervention smok- ing cessation programme from Texas and Rhode Island.
Remember that several anti-dysrhythmic drugs can The European Resuscitation Council provides guidelines for themselves cause dysrhythmias and shorten life diflucan 200mg low price antifungal yeast infection over the counter. Largely Diltiazem voltage-dependent Ca2 conductance superseded by adenosine for treating acute attacks. Digoxin (rapid atrial fibrillation) Shout for help Atropine (symptomatic sinus bradycardia) Adenosine (supraventricular tachycardia) Open airway Adrenaline (cardiac arrest) Calcium chloride (ventricular tachycardia caused by Not breathing normally? When a person is found to have collapsed, make a quick check to ensure that no live power lines are in the immediate vicin- Precordial thump if ity. Otherwise roll them on their back (on a firm surface if possible) and loosen the clothing around the throat. Tilt the head and lift the chin, and sweep an index finger 2 breaths through the mouth to clear any obstruction (e. If the patient is not breathing spontaneously, start mouth- Continue until breathing and pulse restored of emergency services arrive to-mouth (or, if available, mouth-to-mask) ventilation. Hypovolaemia Cardiac tamponade (Redrawn with permission from the Hypo/hyperkalaemia/other metabolic disturbance Toxins European Resuscitation Council Hypothermia Thrombosis (coronary or pulmonary) Guidelines, 2005. Check for a pulse by feeling carefully for the carotid or femoral artery before diagnosing cardiac arrest. If no pulse is palpable, start cardiac compression over the middle of the lower half of the sternum at a rate of Basic cardiopulmonary resuscitation is continued throughout as 100 per minute and an excursion of 4–5cm. Allow two breaths described above, and it should not be interrupted for more than per 30 chest compressions. The electrocardiogram is likely to show asystole, severe bradycardia or ventricular fibrillation. Once the diagnosis is unlikely to achieve or to maintain sinus rhythm in patients definite, administer adrenaline (otherwise known as epineph- with longstanding atrial fibrillation, or with atrial fibrillation rine), 1mg intravenously, followed by atropine, 3mg intra- secondary to mitral stenosis, especially if the left atrium is sig- venously. Further doses of adrenaline 1mg can be given every nificantly enlarged; in such cases, it is quite acceptable to aim three minutes as necessary. If P-waves (or other electrical activ- for rate control rather than rhythm conversion. Indeed, trials ity) are present, but the intrinsic rate is slow or there is high have demonstrated no difference in prognosis between grade heart block, consider pacing. The The following sequence is used until a rhythm (hopefully main hazard of cardioversion is embolization of cerebral or sinus) is achieved that sustains a cardiac output. Patients should therefore be anti- and then repeated (200J, then 360J) if necessary, followed by coagulated before elective cardioversion (usually for four to six adrenaline, 1mg intravenously, and further defibrillation weeks) to prevent new and friable thrombus from accumulat- (360J) repeated as necessary. Consider varying the paddle ing and to permit any existing thrombus to organize, thereby positions and also consider amiodarone 300mg, if ventricular reducing the risk of embolization. A further dose of 150mg may be required early cardioversion provided that transoesophageal echocar- in refractory cases, followed by an infusion of 1mg/min for diography can be performed and shows no evidence of throm- six hours and then 0. Lidocaine and procainamide persists or intermittent episodes of dysrhythmia recur. It may be the result of severe global damage to the left ventricle, in which Paroxysmal supraventricular tachycardias case the outlook is bleak. Criteria exist for distinguishing broad bradycardia, atropine, 3mg intravenously or 6mg via the complex supraventricular and ventricular tachycardias, but endotracheal tube, should be given. High-dose adrenaline is these are beyond the scope of this book, and in practice no longer recommended in this situation. In an acute setting (most commonly the immediate after- Ventricular dysrhythmias math of myocardial infarction), treatment to suppress ventricu- Ventricular ectopic beats: Electrolyte disturbance, smoking, lar ectopic beats may be warranted if these are running alcohol abuse and excessive caffeine consumption should be together to form brief recurrent episodes of ventricular tachy- sought and corrected if present. The only justification for cardia, or if frequent ectopic beats are present following car- treating patients with anti-dysrhythmic drugs in an attempt to dioversion from ventricular fibrillation. An effective plasma concentration is rapidly achieved by giv- Ventricular fibrillation: See above under Advanced life sup- ing a bolus intravenously followed by a constant rate infusion. Pacemaker insertion is indicated if bradycardia is unresponsive to atropine and is causing significant hypotension. Pharmacokinetics Oral bioavailability is poor because of presystemic metabolism Sick sinus syndrome (tachycardia–bradycardia and lidocaine is given intravenously. It is metabolized in the syndrome) liver, its clearance being limited by hepatic blood flow. Heart fail- ure reduces lidocaine clearance, predisposing to toxicity unless Treatment is difficult.
For all forms of eczema cheap 50 mg diflucan amex antifungal ointment for dogs, the following tips can help reduce flare-ups: • Use only hypoallergenic skin products, soaps, and detergents and rinse well with water. Look for creams that are thick and emollient and contain one or more of the following: chamomile; vitamins A, E, and C; calendula; licorice; and lavender. Complementary Supplements Celadrin: A mixture of fatty acids that reduce inflammation. Probiotics: Beneficial bacteria with immune-regulating properties; help improve digestion and reduce allergic reactions. Witch hazel: An astringent that helps dry up weeping eczema and reduces itching and inflammation. Probiotics may be helpful for those with digestive problems and to reduce allergic responses. However, because there is nowhere for this blood to exit the body, it becomes trapped, irritates surrounding tis- sue, and may cause scar tissue to form, which is painful. The actual cause is unknown; however, it is known that endometriosis is an estrogen- dependent condition and estrogen is necessary to induce or maintain endometriosis. One theory is that menstrual blood containing endometrial cells flows back through the fallopian tubes, and cells start to grow outside the uterus. Many women have E some retrograde menstrual flow, yet the immune system is able to clear the debris and prevent implantation and growth of cells. It is thought that a compromised immune system or environmental toxins (xenoestrogens) may be at play. Since endometriosis often occurs in those with a family history, it is possible that there could be a genetic flaw. Another theory is that endometrial cells are carried via the bloodstream to other sites in the body. While endometriosis can be painful, it doesn’t increase the risk of uterine cancer or ovarian cancer, and there are a number of lifestyle approaches and natural rem- edies that can be very helpful. Endometriosis can produce adhesions that can trap the egg near the ovary and prevent it from travelling through the fallopian tube to the uterus. Despite this, many women with endometriosis are still able to conceive, but it often takes them longer. Oral contraceptives are sometimes used to regulate hormone levels and control heavy bleeding. For women having difficulty conceiving, laparoscopic laser techniques can be done to shrink and remove lesions. Hysterectomy should be considered only as a last resort for those with severe symptoms that have not benefited from other conventional and natural approaches. Having this radical surgery does not guarantee an end to the symptoms and is associ- ated with various risks and complications. Dietary Recommendations Foods to include: • Increase intake of whole grains, fresh vegetables, and fruits. These foods are high in fibre and help balance levels of friendly bacteria in the intestine. Foods to avoid: • Alcohol, caffeine, refined foods, food additives, sugar, and saturated fats may affect hor- mone balance, impair immune function, and worsen symptoms. Lifestyle Suggestions • Have regular pelvic examinations and report any changes in symptoms to your doctor. Kegel exercises (contracting and releasing the pelvic muscles) may help release pelvic tension. They block menstrual flow and may increase the likelihood of retro- grade blood flow. Top Recommended Supplements Calcium D-glucarate: Helps the liver detoxify and eliminate excess hormones (particularly estrogen). Chasteberry: Balances the estrogen to progesterone ratio and may help normalize ovula- tion. Indole-3-carbinol: A compound found naturally in cruciferous vegetables that aids in de- toxification of estrogen, protects liver function, and may protect against hormonal cancers.
