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Self-rated health as a predictor of mortality in a sample of coronary artery disease patients type 2 diabetes prevention journal articles 50mg cozaar with amex. Use of postmenopausal hormone replacement therapy: Estimates from a nationally representative cohort study diabetic diet on insulin cheap cozaar 25 mg. Compliance with cardiovascular disease prevention strategies: A review of the research blood glucose 2 hour test cozaar 25mg on-line. Best methods for analysis of change: Recent advances blood sugar weight loss 50 mg cozaar mastercard, unanswered questions, future directions. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Do coronary heart disease risk factors measured in the elderly have the same 504 Adult Development and Aging Contrada, R. Inherited frailty: ApoE Alleles determine survival after a diagnosis of heart disease or stroke at ages 85. Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer. Cutting edge research in personality: the importance of personality disorders to understanding normal aging. Personality at midlife: Stability, intrinsic motivation and responses to life events. Continuity and change over the adult life cycle: Personality and personality disorders. Bene"t of a favorable cardiovascular risk-factor pro"le in middle age with respect to Medicare costs. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Identi"cation of normal aging and disease-related processes by health care professionals. Comparative effects of age and blood pressure on neuropsychological test performance. Cardiovascular risk factors and cognitive functioning: An epidemiological perspective. In"uence of essential hypertension on intellectual performance: Causation or speculation. Untreated blood pressure is inversely related to cognitive functioning: the Framingham Study. Blood pressure, hypertension, and age as risk factors for poor cognitive performance. Patient noncompliance with hormone replacement therapy: A nationwide estimate using a large prescription claims database. Comorbidity of "ve chronic health conditions in elderly community residents: Determinants and impact on mortality. Journal of Gerontology: Series A, Biological Sciences and Medical Science, 55(2), M84. In"uence of social network on occurrence of dementia: A community based longitudinal study. Aging in the eighties: Impaired senses for sound and light in persons age 65 years and over. Cancer prevalence and survivorship issues: Analyses of the 1992 National Health Interview Survey. Under-representation of patients 65 years of age or older in cancer treatment trials. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: A study of the United Kingdom population. Factors of risk in the development of coronary heart disease,six-year follow-up experience: the Framingham Study.

Finally diabetes 44 spice order cozaar 25 mg free shipping, behavioral follow-through diabetes symptoms normal blood sugar levels buy cozaar 25mg on-line,actually using medications when the need to do so is identi"ed type 1 diabetes quizlet cozaar 50mg on line,is yet another independent step in appropriate self-management metabolic disease examples buy generic cozaar 25 mg line. There are alarming reports of signi"cant delays in seeking treatment, despite patients· reported awareness of decreased respiratory function in the 24 to 48 hours prior to obtaining treatment. In a subset of persons with severe asthma, the inability to perceive changes in air"ow may be life threatening or fatal. For example, a comparison of patients who had near fatal asthma attacks, patients with asthma without near-fatal attacks, and a group of participants without asthma revealed that patients who had a near fatal attack had a blunted respiratory response to hypoxia generated by rebreathing (breathing within a con"ned space, resulting in gradually increasing carbon dioxide as the available air is recycled), and their perception of dyspnea was lower than participants without asthma (Kikuchi et al. Inaccurate perception of respiratory status has been associated with repressive-defensive coping (see also next section) (Isenberg, Lehrer, & Hochron, 1997; Steiner, Higgs, & Fritz, 1987). Timely and accurate perception of your respiratory status is central to appropriate asthma self-management, but research suggests a good deal of variability among patients· perceptual abilities that may have life-threatening consequences. Psychoanalytic Theory From the psychoanalytic perspective, asthma has been posited to develop in response to repressed emotions and emotional expression, such as repressed crying (Alexander, 1955). This perspective views asthma as a psychosomatic illness, suggesting direct causal links between psychological factors and disease. The psychoanalytically-informed literature related to asthma is largely limited to case studies and other clinical materials. Two areas of empirical research, however, may have been in"uenced by these early psychoanalytic formulations, namely, research on alexithymia and the repressive-defensive coping style. Alexithymia Dif"culty in labeling and expressing emotions has been termed alexithymia (Nemiah, 1996). They found that alexithymic patients were more likely to be rehospitalized and had longer lengths of stay than did non-alexithymic patients (Dirks, Robinson, & Dirks, 1981); these differences were not attributable to underlying asthma severity. More recently, it has been shown that dif"culty distinguishing between feelings and bodily sensations, as measured by the Toronto Alexithymia Scale, is related to greater report of asthma symptomatology, but not objective measures of pulmonary Evidence Basis for Psychological Theories Applied to Mechanisms Involved in Asthma 103 function (Feldman, Lehrer, Carr, & Hochron, 1998). One possible interpretation of these results is that asthma symptom complaints may be more accessible (to the patient) and socially acceptable ways to communicate distress than are emotions among patients who may be characterized as alexithymic. Helping such patients identify emotions, cope with emotional arousal, and discriminate emotional reactions from asthma symptoms could lead to more appropriate utilization of medical resources. Repressive-Defensive Coping Style More recently, the repressive-defensive coping style has received attention in relationship to persons with asthma and other chronic medical conditions. This style is characterized by the co-occurrence of low levels of self-reported distress, high levels of self-reported defensiveness, and high levels of objectively measured arousal and physiological reactivity. In adults, repressive-defensive coping has been associated with immune system down-regulation (Jamner, Schwartz, & Leigh, 1988). Among persons with asthma, immune system down-regulation could increase risk for respiratory infections, which are known to exacerbate asthma through several possible mechanisms (Wright et al. Adults with asthma who display the repressive-defensive coping style were found to display a decline in pulmonary function after exposure to laboratory tasks. However, among samples of children with asthma, repressive-defensive coping style was not characteristic of a majority of children, was not associated with more physiological reactivity under stress (Nassau, Fritz, & McQuaid, 2000), and was associated with more accurate symptom perception (Fritz, McQuaid, Spirito, & Klein, 1996), which would not be predicted by a psychosomatic model. Alexithymia and the repressive-defensive coping style appear to be the most well-operationalized concepts that have roots in psychoanalytic theory and have been implicated among persons with asthma. However, the utility of these constructs in explaining important asthma-related processes such as symptom onset, expression, variability, course, and outcomes, is limited based on current research. Despite the data on repressive-defensive coping among children with asthma not providing robust support for predicted results, research on repressive-defensive coping among adults is warranted since adults· styles may be more polarized and may exert a stronger in"uence on self-management behavior than among children, who share self-management responsibilities with parents and other responsible adults. Family Systems Theory Family systems models have been explored in relationship to children and adolescents with asthma, and will be mentioned only brie"y here. The classic systemic view of family dynamics that creates and perpetuates a ·psychosomaticZ illness such as asthma was outlined by Minuchin, Rosman, and Baker (1978). These dysfunctional dynamics include rigidity, overprotectiveness, enmeshment, and lack of con"ict resolution. In the systemic view, the function of the illness is to diffuse con"ict and maintain homeostasis in the family. Akin to the status of support for psychoanalytic theories related to asthma, evidence to corroborate a systemic view is largely based on clinical anecdotes, although a few attempts to operationalize and assess key family dynamics exist. Families with and without a child with asthma engaged in a decision-making task (Di Blasio, Molinari, Peri, & Taverna, 1990). Families with a child with asthma were characterized by protracted decision-making times, chaotic responses, lack of agreement, and acquiescence to the child·s wishes, which may re"ect an overprotective stance and dif"culties with con"ict resolution, as would be suggested by systems theory. Observational studies have found mothers of children with asthma to be more critical of their children than mothers of healthy children (Hermanns, Florin, Dietrich, Rieger, & Hahlweg, 1989; F.

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Repeated treatment failure may ultimately precipitate the onset of more serious major mood disorders requiring psychological or pharmacological treatment blood sugar over 200 cozaar 50mg overnight delivery. Other studies provide more direct evidence of the potential utility of cognitive behavior interventions to ameliorate psychological distress and improve health outcomes blood sugar pass out generic 50 mg cozaar mastercard. These studies diabetic diet kit buy cozaar 25 mg low cost, along with "ndings from studies involving the use of support groups (Kelly et al diabetes prevention games discount 25 mg cozaar otc. Several biomedical factors, including prior experience with antiretroviral medications, disease stage, and the timing of the initiation of combination therapies can contribute to poor treatment response (Fatkenheuer et al. Combination therapy regimens have been described as being perhaps the most rigorous, demanding, and unforgiving of any outpatient oral treatments ever introduced (Rabkin & Chesney, 1999). Combination therapy regimens typically require patients to take a protease inhibitor and two or more antiretroviral therapies throughout the day and night, often at varying time intervals. Some treatments must be taken on an empty stomach, whereas others are to be taken with food. To complicate matters further, some medications must be kept in refrigeration whereas others do not. Although efforts are underway to develop simpli"ed treatment regimens (Cohen, Hellinger, & Norris, 2000), treatments will continue to be complex, requiring considerable patient effort and tracking. Several studies document a strong association between poor adherence and failure to suppress viral load (Montaner et al. Patients with less than 80% adherence faired even worse, with only 20% of those patients avoiding drug failure. Moreover, patients with adherence of 95% or greater had fewer days in the hospital than those with less than 95% adherence, and experienced no opportunistic infections or deaths. The unforgiving nature of combination therapy treatments suggests that many patients who initiate combination therapies have a time-limited opportunity to succeed with treatment. Even brief drug holidays can lead to rapid viral replication, drug resistance, and (ultimately) failure to respond to other combination therapies. Further, patients initiating combination therapy treatments face what may well be a lifetime of intensive pill taking, given the inevitability of rapid viral ·reboundZ among patients who discontinue therapy (Dornadula et al. The complexity of the drug regimen is not the only factor rendering treatment adherence a challenge. Under even the best of circumstances, combination therapy can cause a host of unpleasant and sometimes severe side effects including fatigue, nausea, vomiting, and diarrhea, as well as longer term side effects. Among patients recruited from an infectious disease clinic, 17% reported missing one or more doses in the last two days, and 31% of respondents reported missing one or more doses of combination therapy in the last "ve days (Catz, Kelly, Bogart, Benotsch, & McAuliffe, 2000). A study comparing the use of self-report, unannounced pill counts, and electronic pill cap monitoring found that median adherence was 89%, 73%, and 67% by self-report, pill count, and electronic medication monitor, respectively (Bangsberg et al. These "ndings highlight the dilemma faced by many physicians when working with individuals whose life circumstances make adequate treatment adherence unlikely. Indeed, some physicians argue that because of the risks of developing multidrug resistance from poor adherence, some newly diagnosed patients may be served best by delaying initiation of combination therapies in favor of "rst treating acute illnesses and resolving other basic psychosocial issues such as substance abuse, housing, and health insurance (Bangsberg, Tulsky, Hecht, & Moss, 1997). Psychosocial factors, including social support, psychological distress, and self-ef"cacy beliefs also appear to be important factors contributing to combination therapy adherence (Catz, et al. In an effort to identify other patient factors that could help to account for missed dosages, several recent studies also report on open-ended responses provided by patients concerning reasons for missed dosages (see Catz et al. Secondary Prevention 235 Finally, aspects of the treatment itself, including patients· knowledge about treatments and their experience with medications in"uence adherence. Confusion regarding treatment doses may be particularly common among patients with limited education and low rates of health literacy. Consistent with earlier studies of adherence prior to the advent of protease inhibitors, multiple side effects also play an important role in missed dosages or drug discontinuation (Catz et al. These include intervention directed both toward individual patients, as well as interventions directed toward health care providers. In other areas of medicine, a common approach to improving patient adherence is to provide targeted interventions to patients who are at greatest risk for adherence problems. Because of the complexities of combination therapy regimens and because many patients come from disadvantaged educational backgrounds, health education strategies should start at the onset of treatment (Wainberg & Cournos, 2000).

For example metabolic disease newborn buy 25mg cozaar free shipping, Taylor·s (1990) con"dent prediction that succinct papers reviewing the current status of health psychology would disappear due to the ·diversity of issues studied and the complexity and sophistication of the models and designs used to explore themZ (p diabetes mellitus and neuropathy purchase cozaar 25 mg on line. Initially diabetic diet restaurant eating discount 25 mg cozaar free shipping, the "eld was composed of 1 researchers and practitioners with common interests in issues related to health and illness who were trained in more traditional (but varied) areas of psychology diabetes mellitus values order cozaar 50 mg visa. The diversity of conceptual approaches, models, and designs brought together by these individuals have helped to establish a "eld that is broad in scope, eclectic, multidisciplinary, dynamic, and allowing for creative developments. Training programs in health psychology have tapped this breadth and students now have signi"cant exposure to neurology, endocrinology, immunology, public health, epidemiology, and other medical subspecialties, in addition to a solid grounding in psychology (Brannon & Feist, 1992). Over the past two decades, health psychologists have become more integrated into the general "eld of health research and intervention, and have gained job opportunities in a range of health-oriented settings (Belar & Deardorf, 1995). Although psychology has been involved with health in some capacity since early in the twentieth century, very few psychologists worked in medical settings, and more as adjuncts than as full members of multidisciplinary teams. The focus of clinical health psychology on empirically supported, brief, problem-centered, cognitive-behavioral interventions and skills training has been compatible with the demands of the managed care system, which must provide authorization for treatment plans. Moreover, the large and continually growing percentage of the gross national product that Americans spend on health care, more than any other industrialized country (over 13. Health Care Financing Administration, 1999), highlights the need to contain costs through early detection and disease prevention. Health psychology research focusing on the development and 2 Introduction evaluation of prevention activities intended to assist with health maintenance and improvement is more cost-ef"cient and can help reduce the need for high cost health care services (Taylor, 1990). Such economic factors have thus helped to facilitate the acceptance of psychologists in the health arena. The future seems bright for continued acceptance of and opportunities for health psychologists as the "eld has demonstrated its value through the contributions made in supporting a biopsychosocial model, as well as with regard to their applied and clinical implications. Surgeon General·s Of"ce continue to highlight the causal importance of behavioral and psychological factors regarding the leading causes of mortality in the United States. As such, health psychologists are in a unique position to conduct research and develop programs geared to prevent and change unhealthy habits and behaviors, as well as to promote healthy ones. However, despite such advances, there is still a tremendous need for work in this area. For example, although an exorbitant amount of money is spent on health care in the United States, this does not necessarily translate to highquality care for most Americans. Comparing mortality and morbidity rates among ethnic/racial groups reveals vast differences. For example, although there has been a general decline in mortality for all groups, overall mortality was 55% greater for Blacks than for Whites in 1997 (Hoyert, Kochanek, & Murphy, 1999). There also are signi"cant health discrepancies relating to socioeconomic status, ethnic/racial status, and even gender. As such, there is a continuing need for health psychology efforts, both research and clinical, to expand in scope. Not only do we need to better understand how biological, psychological, and social factors interact with each other regarding various symptom clusters and medical disorders, but also we need to improve the manner in which health care delivery is provided. Research needs to be conducted regarding the impact of health care policy on health and well-being. Therefore, lest we begin to wish to sit on our laurels and believe that our job is nearly done in terms of health psychology research and clinical applications, we should remember the words of John Locke concerning overcon"dence: He that judges without informing himself to the upmost that he is capable, cannot acquit himself of judging amiss. This current volume should be viewed as but one major stop on a road that will continue far into the future. However, the road thus far has been very fruitful, as evidenced by the rich material contained in the various chapters in this volume. Testing the biopsychosocial model: the ultimate challenge facing behavioral medicine? More and more evidence is accumulating for the role of behavior in current trends of morbidity and mortality: Certain health behaviors reduce morbidity and mortality (Breslow & Enstrom, 1980; Broome & Llewellyn, 1995; Marks, Murray, Evans, & Willig, 2000; Matarazzo, Weiss, Herd, Miller, & Weiss, 1984; Taylor, 1986). Donker, Nederlands Institut van Psychogen; Zenia Jepsen, Dansk Psykologforening; Jesus Rodriguez-Marin, Colegio O"cial de Psicologos; Sylvaine Sidot, Association Nationale des Organizations de Psychologues; Brit Wallin Backman, Norsk Psykologforening.