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By I. Tragak. Mercer University.

The results from this analysis showed that greater improvement in health was associated with a high number of positive emotion words and a moderate number of negative emotion words generic unisom 25mg on-line. More interestingly order 25 mg unisom with visa, they also found that those who showed a shift towards more causal and insight words also showed greater improvement (Pennebaker et al unisom 25 mg sale. They con- cluded from this that this shift in language use reflected a shift from poorly organized descriptions towards a coherent story and that a coherent story was associated with better health status generic 25mg unisom with mastercard. Stress Stress can cause illness through physiological changes such as raised heart rate purchase unisom 25 mg overnight delivery, blood pressure, heart beat irregularities and an increase in fatty deposits (see above). Research on rats showed that stressors such as tail pinching, a loud noise and electric shocks could produce immunosuppression (Moynihan and Ader 1996). One area of research which has received much attention relates to the impact of caregiver stress. Using a punch biopsy which involves removing a small area of skin and tissue they explored the relationship between caregiver stress and the wound healing process. The results showed that wound healing was slower in the caregivers than the control group. The wound healing para- digm has also been used to show links between stress and slower healing in students during an exam period (Marucha et al. Herbert and Cohen (1993) carried out a meta analysis of 38 studies which had explored the stress–immune system link. Given that stress can change health behaviours (see above) it is possible that stress causes changes in the immune system by changing behaviour. The results showed that stress was related to wound healing regardless of changes in behaviour indicating that the stress–immunity link may not be explained by an unhealthy lifestyle. In particular, cortisol decreases the number of active T- cells, which could increase the rate of tumour development. This suggests that stress whilst ill could exacerbate the illness through physiological changes. However, stress may also be a result of the illness itself such as relationship breakdown, changes in occupation or simply the distress from a diagnosis. Therefore, if the illness is appraised as being stressful, this itself may be damaging to the chances of recovery. However, many people exist in a life of ongoing chronic stressors including poverty, unemployment, job stress and marital conflict. There is much research linking these social factors to health inequalities with research consistently showing that psychological distress, coronary heart disease and most cancers are more prevalent among lower class individuals who have more chronic stress in their lives (e. However, untangling this relationship is difficult as although chronic stressors such as poverty may cause heart disease they are also linked to a range of other factors such as nutrition, hygiene, smoking, social support which are also linked to health status. Furthermore, whereas lower socioeconomic position is linked to chronic stressors such as poverty, higher socio-economic position is linked higher perceived stress (Heslop et al. As a result of these methodological problems many researchers have focused on specific areas of chronic stress including job stress and relationship stress. Job stress Occupational stress has been studied primarily as a means to minimize work related illness but also as it provides a forum to clarify the relationship between stress and illness. Early work on occupational stress highlighted the importance of a range of job related factors including work overload, poor work relationships, poor control over work and role ambiguity. According to the model, there are two aspects of job strain: job demands, which reflect conditions that effect performance, and job autonomy, which reflects the control over the speed or the nature of decisions made within the job. Karasek’s job demand and control model suggests that high job demands and low job autonomy (control) predicts coronary heart disease. Karasek and co-workers have since developed the job demand control hypothesis to include social support. Within this context, social support is defined as either emotional support, involving trust between colleagues and social cohesion, or instrumental social support involving the provision of extra resources and assistance. It is argued that high social support mediates and moderates the effects of low control and high job demand. Karasek and Theorell (1990) report a study in which subjects were divided into low social support and high social support groups, and their decisional control and the demands of their job were measured.

The discomfort is typically predictable and reproducible unisom 25mg lowest price, with the frequency of attacks constant over time buy cheap unisom 25 mg line. The dis- comfort is thought to be caused by fixed generic 25 mg unisom with mastercard, stenotic atherosclerotic plaques that narrow a blood vessel lumen and reduce coronary blood flow (d and e) generic unisom 25 mg overnight delivery. Sinus bradycardia (e) is similar to sinus rhythm except that the rate is less than 60 and generally greater than 45 buy unisom 25 mg with amex. There are several etiologies of sinus bradycardia; some are normal (eg, young person, well-trained athlete) and some pathologic (eg, β-blocker overdose, cardiac ischemia). The immediate step in managing complete heart block is applying a transcutaneous pacemaker for ventric- ular pacing as a temporizing measure. However, patients need implantable ventricular pacemakers for definitive management. Cardioversion (b) is used to treat unsta- ble patients with reentrant arrhythmias, such as atrial fibrillation. Over the next hour, you notice that not only are her tongue and lips getting more swollen, but her face is starting to swell, too. She states that a few moments after landing she felt short of breath and felt pain in her chest when she took a deep breath. You send her for a duplex ultrasound of her legs, which is positive for deep vein thrombosis. Place patient on a monitor, provide supplemental oxygen, and administer unfractionated heparin. Place the patient on a monitor, provide supplemental oxygen, and administer warfarin. She also describes coughing up “chicken livers” during this time and reports that her symptoms are getting progressively worse. She states that she has a history of alcohol abuse, but denies tak- ing any medications or illicit drugs. Given this patient’s clinical presentation, which of the following is this patient at most risk for contracting? The patient reports sitting at his desk when he felt a sharp pain on the right side of his chest that worsened with inspiration. Which of the following organism is the most common cause of community acquired bacterial pneumonia? Upon returning to the United States, the patient developed a persistent cough associated with dyspnea. She was seen by a pulmonologist, who diagnosed her with bronchitis and prescribed an inhaler. However, over the following weeks, the patient’s symptoms worsened, and she devel- oped pleuritic chest pain. Given this patient’s history and pre- sentation, what is the most likely etiology of her symptoms? Upon arrival, she is tachypneic at 24 breaths per minute with an oxygen saturation of 97% on face mask oxygen administration. Upon physical examination, the patient appears to be in mild distress with supraclavicular retractions. She refuses to answer questions for the interview, but repeatedly states that she is feeling short of breath. Her physical examination is unre- markable, except for a systolic ejection murmur. After placing the patient on oxygen and a monitor, which of the following should be performed first? Which of the following agents is most likely responsible for this patient’s presentation? The patient denies any loss of conscious- ness and reports feeling short of breath. Her initial chest x-ray appears normal; however she continues to be symptomatic with stable vital signs. As you evaluate a patient with shortness of breath, you appreciate decreased breath sounds at the left-lung base.

These might lieved children were born with certain dispositions that be maternal viruses such as rubella (German measles) or could be changed by their environment unisom 25 mg. Expo- mans expressed great affection for their children in let- sure to nicotine is linked to premature birth purchase unisom 25mg with visa, low birth ters and on tombstones order 25 mg unisom fast delivery. During the Middle Ages buy 25mg unisom overnight delivery, little weight cheap unisom 25mg on line, and cleft (malformed) palate and lips, while ex- distinction was made between adults and children, who posure to alcohol is linked to intellectual and behavioral worked from a very young age. An inadequate maternal diet also puts the beginning of the nuclear family in Europe, with an in- fetus at risk, especially its brain and nervous system. The vast majority of babies, however, are born ical school of philosophy, believed the child enters the healthy and normal. Jean-Jacques Rousseau (1712-1778) took the opposite tack, recommending that education should Infancy follow nature since infants automatically prefer good- Newborns enter the world with many skills. According to Sigmund Freud’s (1856-1939) psy- tion to a range of adaptive reflexes such as grasping, choanalytic theory, children must pass through five psy- sucking, and rooting (turning the head when the cheek is chosexual stages to achieve healthy adulthood. In con- touched), they are able to recognize their mothers’ face, trast behaviorist John Watson (1878-1935) asserted voice, and smell. Even more impressive, less than one that, given a controlled environment, he could train a hour after birth, babies can imitate gestures such as child to be anything from doctor to thief. By age two for girls and two-and-a-half for boys, babies reach half their Prenatal development adult height. Physical development is largely pro- The future adult begins not at birth but at concep- grammed by a genetically determined timetable called tion, with the creation of a unique set of genes, half from maturation, which proceeds in predictable stages. This genetic blueprint is healthy, well-nourished babies, progress is influenced called the genotype; its outward manifestation is the phe- only slightly by environment, although they need oppor- notype. More often, the The rate of physical growth slows after the second phenotype represents the interaction of the genotype and year, not accelerating again until puberty. It is even possible for the genotype to rate of growth are genetically determined. In industrial- be altered by the environment, as happens when men ex- ized societies, puberty begins at 10 for girls and 12 for posed to certain toxins suffer an increased risk of father- boys, ages that have declined significantly over the past ing children with genetic abnormalities. Fewer than half of fertilized eggs, called zygotes, survive the first two weeks during which the zygote Intellectual development moves from the fallopian tube where it was fertilized to the uterus where it is implanted. During the next six The Swiss researcher Jean Piaget (1896-1980) pio- weeks, the zygote differentiates into an embryo with in- neered the field of cognitive, or intellectual, development. In the final seven months of gestation, the he divided children’s thinking into four qualitatively dis- maturing skeletal, muscular, and nervous systems of tinct stages, moving from a direct sensory understanding what is now called the fetus make movement possible. There is strong evi- found that, contrary to Piaget’s theory, even babies seem dence for a biological component to personality dimen- to understand basic principles like object permanence, sions like sociability, irritability, neuroticism, and con- the concept that objects continue to exist when hidden. A baby’s innate sociability, for example, can be been confirmed, far fewer people attain Piaget’s final squelched by a depressed mother, or a child’s innate irri- stage of logical reasoning than he predicted. In general, how- ever, personality characteristics remain stable from in- Other theories of learning attribute cognitive devel- fancy to adolescence. Conditioning works by encouraging behavior Social development through reinforcement or discouraging it through pun- ishment. Social learning theory adds another mecha- Children grow up in a web of social relationships. The first and most important is the bond between infant and mother called attachment. Attachment is crucial be- Intelligence cause securely attached babies tend to become sociable, confident, independent, and emotionally mature chil- The measurement of intelligence, psychometrics, dren. Adolescents who feel close to their parents also began with Sir Francis Galton (1822-1911). Another his measures of vision, reaction time, and grip strength predictor of social success is physical attractiveness. A cycle pares mental age to chronological age, with average in- of aggression and rejection often persists into adulthood. Purely environmental models Language learning such as behaviorism have been contradicted by numer- Perhaps the most crucial task of childhood is learn- ous studies showing a strong genetic influence for every- ing to communicate. Researchers have found that hu- thing from intelligence to shyness to sexual orientation.

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