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The results showed that at the end of this period cheap raloxifene 60mg, 11 per cent had died from coronary heart disease and that those longshoremen who expended more than 8500 kcal per week had a significantly lower risk of coronary heart disease than those in jobs requiring less energy raloxifene 60 mg overnight delivery. This difference remained when other risk factors such as smoking and blood pressure were controlled purchase raloxifene 60 mg on line. This relationship between occupational activity and coronary heart disease has also been shown in samples of both men and women (Salonen et al order 60 mg raloxifene with mastercard. Research has also evaluated the relationship between leisure-time activity and coronary heart disease buy raloxifene 60 mg on-line. The results showed that those who attempted to keep fit showed less than half the incidence of coronary heart disease at follow-up compared with the other subjects. Exercise may influence coronary heart disease in the following ways: 1 Increased muscular activity may protect the cardiovascular system by stimulating the muscles that support the heart. The physical benefits of exercise have been summarized by Smith and Jacobson (1989) as: (1) improved cardiovascular function; (2) increased muscle size and strength and ligament strength for maintaining posture, preventing joint instability and decreasing back pain; (3) improved work effort; and (4) changing body composition. The psychological benefits of exercise Research also indicates that exercise may improve psychological well-being. These effects are outlined below: Depression Research using correlational designs suggests an association between the amount of exercise carried out by an individual and their level of depression. Much of the reviews into this association have stressed the correlational nature of the research and the inherent problems in determining causality (e. However, McDonald and Hodgdon (1991) carried out a meta-analysis of both the correlational and experimental research into the association between depression and exercise. They concluded that aerobic exercise was related to a decrease in depression and that this effect was greatest in those with higher levels of initial depressive symptoms. In an attempt to clarify the problem of causality, McCann and Holmes (1984) carried out an experimental study to evaluate the effect of manipulating exercise levels on depression. After five weeks, the results showed a significant reduction in depressive symptomatology in the exercise group compared with the other two subject groups supporting the relationship between exercise and depression and suggesting a causal link between these two variables; that is, increased exercise resulted in a reduction in depression. The results showed improvements in affect from baseline to follow up which supports previous research suggesting that exercise is beneficial. The authors suggest that although prolonged exercise may improve mood this dip in mood may explain why people fail to adhere to exercise programmes. Anxiety Research has also indicated that exercise may be linked to a reduction in anxiety. Again, there are problems with determining the direction of causality in this relationship, but it has been suggested that exercise may decrease anxiety by diverting the individual’s attention away from the source of anxiety. Response to stress Exercise has been presented as a mediating factor for the stress response (see Chapters 10 and 11). Exercise may influence stress either by changing an individual’s appraisal of a potentially stressful event by distraction or diversion (e. Self-esteem and self-confidence It has also been suggested that exercise may enhance an individual’s psychological well- being by improving self-esteem and self-confidence. In addition, exercise may result in an improved sense of achievement and self-efficacy. Many theories have been developed to explain the factors that mediate the link between exercise and psychological state. These reflect both the physiological and psychological approaches to the study of exercise. For example, it has been argued that exercise results in the release of endorphins, the brain’s natural opioids (Steinberg and Sykes 1985), and increases in the levels of brain norepinephrine, which have been hypothesized to be a cause of depression. It has also been suggested that improved psychological state is related to the social activity often associated with exercise and the resulting increased confidence and self-esteem. Any reduction in levels of depression may be related to greater social contact, improved social support and increased self- efficacy. Because of the experimental design, the results allow some conclusions to be made about the direction of causality. However, as with many health- related behaviours, adherence to health promotion recommendations may be more motivated by short-term immediate effects (e. Therefore, understanding the immediate effects of exercise on mood has obvious implications for encouraging individuals to take regular exercise.

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Studies have shown that yoga has provided beneficial effects to some individuals with back pain discount raloxifene 60mg visa, stress cheap raloxifene 60mg free shipping, migraine purchase raloxifene 60mg, insomnia discount 60mg raloxifene mastercard, high blood pressure purchase raloxifene 60mg with visa, rapid heart rates, and limited mobility (Sadock & Sadock, 2007; Steinberg, 2002; Trivieri & Anderson, 2002). Evidence has shown that animals can directly influence a person’s mental and physical well-being. Many pet-therapy programs have been established across the country and the numbers are increasing regularly. Several studies have provided information about the positive results of human interaction with pets. Another study revealed that animal-assisted therapy with nursing home residents significantly reduced loneliness for those in the study group (Banks & Banks, 2002). One study of 96 patients who had been admitted to a cor- onary care unit for heart attack or angina revealed that in the year following hospitalization, the mortality rate among those who did not own pets was 22% higher than that among pet owners (Whitaker, 2000). Some researchers believe that animals may actually retard the aging process among those who live alone. Loneliness often results in premature death, and having a pet mitigates the ef- fects of loneliness and isolation. Whitaker (2000) has suggested: Though owning a pet doesn’t make you immune to illness, pet own- ers are, on the whole, healthier than those who don’t own pets. Study after study shows that people with pets have fewer minor health problems, require fewer visits to the doctor and less medication, and have fewer risk factors for heart disease, such as high blood pressure or cholesterol levels (p. It may never be known precisely why animals affect humans they way they do, but for those who have pets to love, the thera- peutic benefits come as no surprise. Pets provide unconditional, nonjudgmental love and affection, which can be the perfect an- tidote for a depressed mood or a stressful situation. The role of animals in the human healing process requires more research, but its validity is now widely accepted in both the medical and lay communities. Most complementary therapies consider the mind and body connection and strive to enhance the body’s own natural healing powers. More than $27 billion a year is spent on alternative medical therapies in the United States. This chapter examined herbal medicine, acupressure, acu- puncture, diet and nutrition, chiropractic medicine, therapeutic touch, massage, yoga, and pet therapy. Nurses must be familiar with these therapies, as more and more clients seek out the heal- ing properties of these complementary care strategies. The separation from loved ones or the giving up of treasured possessions, for whatever reason; the experience of failure, either real or perceived; or life events that create change in a familiar pattern of existence—all can be experienced as loss, and all can trigger behaviors associated with the grieving pro- cess. Loss and bereavement are universal events encountered by all beings who experience emotions. A significant other (person or pet) through death, divorce, or separation for any reason. Examples include (but are not limited to) diabetes, stroke, cancer, rheumatoid arthritis, multiple sclerosis, Alzheimer’s disease, hearing or vision loss, and spinal cord or head injuries. Some of these conditions not only incur a loss of physical and/or emotional wellness but may also result in the loss of personal independence. Developmental/maturational changes or situations, such as menopause, andropause, infertility, “empty nest” syndrome, aging, impotence, or hysterectomy. A decrease in self-esteem, if one is unable to meet self-expectations or the expectations of others (even if these expectations are only perceived by the individual as unfulfilled). Separation from these familiar and per- sonally valued external objects represents a loss of material extensions of the self. Some texts differentiate the terms mourning and grief by describing mourning as the psychological process (or stages) through which the individual passes on the way to successful adaptation to the loss of a valued object. Grief may be viewed 390 Loss and Bereavement ● 391 as the subjective states that accompany mourning, or the emo- tional work involved in the mourning process. For purposes of this text, grief work and the process of mourning are collectively referred to as the grief response. Theoretical Perspectives on Loss and Bereavement (Symptomatology) Stages of Grief Behavior patterns associated with the grief response include many individual variations. However, sufficient similarities have been observed to warrant characterization of grief as a syndrome that has a predictable course with an expected resolution. Early theorists, including Kübler-Ross (1969), Bowlby (1961), and Engel (1964), described behavioral stages through which indi- viduals advance in their progression toward resolution. Some individuals may reach acceptance, only to revert to an earlier stage; some may never complete the sequence; and some may never progress beyond the initial stage.

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Dietary Recommendations Foods to include: • A small snack before bed of food that contains tryptophan (an amino acid) stimulates the release of serotonin purchase raloxifene 60 mg amex, a brain chemical that facilitates sleep buy 60mg raloxifene overnight delivery. Foods to avoid: • Caffeine (coffee generic raloxifene 60 mg with mastercard, tea cheap raloxifene 60mg fast delivery, pop buy cheap raloxifene 60mg, and chocolate) can affect sleep quality, and should be avoided eight hours before bed. Leaving only five or six hours may make you feel stressed and affect your ability to fall asleep. Top Recommended Supplements Melatonin: A hormone that is naturally secreted by the brain in response to darkness and regulates sleep/wake cycles. Supplements reduce the time needed to fall asleep, reduce nighttime wakening, and improve sleep quality. It is particularly helpful for those who work shifts or travel to different time zones (jet lag). Valerian: An herb that is widely used for insomnia; it improves many aspects of sleep and is non-addictive. Some formulas combine valerian with hops, passion flower, and other herbs that promote relaxation. Complementary Supplements Calcium and magnesium: Important minerals for muscle and nervous system relaxation. Note: Supplements that promote sleep should be used only occasionally, as it is important to address the underlying factors causing insomnia. It is also one of the most common reasons for a doctor’s appointment, especially among women. It is characterized by abdominal pain or cramping and changes in bowel function, such as bloating, gas, diarrhea, and constipation, which makes it a sensitive topic to discuss. The walls of the intestines are lined with layers of muscle that contract and relax as they move food from your stomach through your intestinal tract to your rectum. With irritable bowel syndrome, the contractions are stronger and last longer, causing food to be forced through your intestines more quickly. In some cases, the opposite occurs and food passage slows, causing dry, hard stools and constipation. Although there is no known cure, there are a number of dietary strategies, supplements, and lifestyle measures that can greatly help to manage this condition. Many people find that their symptoms worsen when they eat certain foods, such as milk, caffeine, wheat, alcohol, artificial sweeteners, or food preservatives. Drugs that regulate gut motility, namely Dicetel (pinaverium bromide) and Modulon (trimebutine maleate), are often prescribed. Anti-diarrheal medications, such as Imodium (loperamide), and laxatives should be used cautiously and only occasionally when under recommendation by your doctor. Fibre supplements, when taken along with adequate fluids, can help control con- stipation and improve bowel function. Anti-spasmodic drugs, such as Bentylol (dicyclomine) and Buscopan (hyoscine), block the transmission of nerve impulses and reduce muscle activity, thus slowing the movement of food through the intestinal tract. Add high-fibre foods to the diet gradually to minimize gas and bloating, and drink plenty of water. Recommended fibre-rich foods include oats, brown rice, milled flaxseed, psyllium, and vegetables. Foods to avoid: • Alcohol, caffeinated beverages, and spicy foods stimulate the intestines and can make diar- rhea and pain worse. Sorbitol and mannitol are found mainly in diabetic and low-carbohydrate foods and snacks. The most commonly implicated foods include wheat, dairy, sugar, and artificial sweeteners. Following an elimina- tion diet (see Appendix D) and using a food and symptom diary can help determine which foods should be avoided. Top Recommended Supplements Digestive enzymes: Help improve food digestion and reduce bloating and gas. Look for a full-spectrum enzyme that contains proteolytic enzymes, lipase and amylase. Flaxseed: Ground flaxseed contains insoluble and insoluble fibres that help reduce consti- pation and promote bowel regularity.

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