By Y. Kalesch. Cleveland State University.

Given that stereotypes cheap bystolic 5 mg amex hypertension or high blood pressure, bias purchase bystolic 5 mg fast delivery blood pressure pills joint pain, and clinical uncertainty may influence clinicians’ diag- nostic and treatment decisions, education may be one of the most important tools as part of an overall strategy to eliminate healthcare disparities. Healthcare providers should be made aware of racial and ethnic disparities in healthcare, and the fact that these dispari- ties exist, often despite providers’ best intentions. In addition, all current and future healthcare providers can benefit from cross-cultural education. Cross-cultural education programs have been developed to enhance health professionals’ awareness of how cul- tural and social factors influence healthcare, while providing methods to obtain, negotiate and manage this information clinically once it is obtained. Cross-cultural education can be divided into three conceptual approaches focusing on attitudes (cultural sensitiv- ity/awareness approach), knowledge (multicultural/categorical approach), and skills (cross-cultural approach), and has been taught using a variety of interactive and experien- 5 tial methodologies. Research to date demonstrates that training is effective in improving provider knowledge of cultural and behavioral aspects of healthcare and building effec- Healthcare providers tive communication strategies. Data on patient and provider race and care, and the fact that ethnicity would allow researchers to better disentangle factors that are associated with these disparities exist, healthcare disparities, help health plans to monitor performance, ensure accountability to often despite provid- enrolled members and payors, improve patient choice, allow for evaluation of interven- ers’ best intentions. Unfortunately, standardized data on racial and ethnic differences in care are generally unavailable, and a number of ethical, logistical, and fiscal concerns present challenges to data collection and monitor- ing, including the need to protect patient privacy, the costs of data collection, and resis- tance from healthcare providers, institutions, plans and patients. In addition, health plans have raised significant concerns about how such data will be analyzed and reported. The challenges to data collection should be addressed, as the costs of failing to assess racial and ethnic disparities in care may outweigh new burdens imposed by data collection and analysis efforts. Many other strategies must be undertaken, in conjunction with the training and edu- cational strategies described here, to eliminate racial and ethnic disparities in healthcare. As noted in the report, these include, for example, policy and regulatory strategies that address fragmentation of health plans along socioeconomic lines, and health systems in- terventions to promote the use of clinical practice guidelines and promote the use of in- terpretation services where community need exists. In short, a comprehensive, multi-level strategy is needed to eliminate these disparities. Broad sectors – including healthcare providers, their patients, payors, health plan purchasers, and society at large – must work Many other strategies together to ensure all patients receive a high quality of healthcare. The following is only a partial list of some of these resources, and is not intended as an endorsement of the products or disparities in health- individuals and groups that produced them: care. Cultural Competence: Essential Measure- ments of Quality for Managed Care Organizations. Kaiser Family Foundation and the Robert Wood Johnson Foundation have recently joined forces to sponsor an initiative to increase dialogue among physicians regarding healthcare disparities. Conscious and nonconscious African American stereotypes: Impact on first impression and diagnostic ratings by therapists. The ef- fect of race and sex on physicians’ recommendations for cardiac catherization. The effect of patient race and socio-economic status on physi- cian’s perceptions of patients. The views presented in this report are those of the Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care and are not necessarily those of the funding agencies. The Institute of Medicine is a private, nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences. Cosmetics can have a psychological and social impact that cannot be underestimated. I want to thank all the contributors for participating in this project and particularly the editors, Perry Romanowski and Randy Schueller, for conceiving, organizing, and coordinating this book. It is the second book that they have contributed to this series and we appreciate their efforts. Special thanks are due to Sandra Beberman and Erin Nihill of the editorial and production staff at Marcel Dekker, Inc. Finally, I would like to thank my wife, Eva, without whose constant support and editorial help I would not have undertaken this project. Sunscreens: Development, Evaluation, and Regulatory Aspects, edited by Nicholas J. Preservative-Free and Self-Preserving Cosmetics and Drugs: Principles and Practice, edited by Jon J. Antiperspirants and Deodorants: Second Edition, Revised and Ex- panded, edited by Karl Laden 21. Conditioning Agents for Hair and Skin, edited by Randy Schueller and Perry Romanowski 22. Principles of Polymer Science and Technology in Cosmetics and Per- sonal Care, edited by E.

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As the most potent of the glucocorticoids discount bystolic 2.5 mg amex blood pressure recommendations, cortisol keeps us alive via three key properties bystolic 5mg for sale heart attack high head shot hotel feat jon johnson. It • raises blood sugar • increases blood pressure • modulates inflammation The Pendulum of Stress and Cortisol: Short Version Stress is unavoidable, rampant, and growing. It’s part of life, and if anyone knows how to live without it, please phone me immediately. It’s not a bad thing in itself: under normal conditions, your body produces a brief surge of cortisol—the hormone released when you’re under stress—that is beneficial and protective and, ideally, infrequent. The stress reaction is an appropriate alarm; perhaps a friend has a medical emergency or your house was burglarized. Once you respond and cope with the situation, your cortisol should return to normal levels, similar to the rise and fall of a tide. When your cortisol is functioning properly and proportionally, so is your alarm system, and vice versa. Far too many of us struggle with symptoms of unrelenting stress and hypervigilance that are listed in Part A of the questionnaire in chapter 1 (such as chocolate cravings, lousy sleep, belly fat, anxiety). If you’re reading this chapter, chances are you’re feeling the ravages of unremitting stress. You may think you can’t make radical changes to your lifestyle in the pursuit of good health, but I am here to tell you that small shifts in how you approach the many roles you’re juggling can start you on a path to a revitalized you. My Slamming Pendulum of Stress In my thirties, I was a textbook example of a chronically stressed woman— and as a result, I experienced the collateral damage of high cortisol. I sweated the small stuff, like traffic and laundry, even making my kids’ lunches. I’d forget to pick up my kids from school, or I’d remember and would have been on time, really, if I could have found my keys. I’d look forward to a glass of wine at the end of the day, but if one glass led to two, my sleep suffered. Despite exercise and a healthy diet, my blood sugar was high, and my sugar cravings overwhelmed my self-control. My waist got thicker, and when the clerk at Whole Foods asked if I was pregnant (when I wasn’t), I nearly went into a rage. I discovered that my perception of stress was the true problem—in other words, I’m responsible for manufacturing much of the stress I feel. Everyone has demands and problems; when I stopped blaming external circumstances for how I felt and improved my mental flexibility, a whole new, hormonally supportive space opened for me. How Women Respond to Stress: Men Fight, Women Talk When men feel stressed, they tend to react in the classic manner, with the fight-or- flight response. Men’s response to stress is thought to be at the root of their poor health relative to women and their lower life expectancy. The original data on stress response was gathered from men by Walter Cannon, the doctor who coined the term fight or flight. Newer data shows that stress elicits a different reaction in women —what Professor Shelley Taylor of the University of California at Los Angeles calls tend and befriend. When I’m socializing with other moms, and we dish about our lives or trouble-shoot behavioral problems in our kids and husbands, we form a network of stress-reducing, protective females and leverage oxytocin, the “love” hormone that also acts as a neurotransmitter (brain chemical). The whole feels much greater than the sum of the parts, as Aristotle famously said, and oxytocin rises in our blood and brains, which lowers cortisol. We used to think men and women released different amounts of cortisol in response to stress, which led to all sorts of speculation about women, high cortisol, and emotionality. What appears to be the case, however, is that rather than just producing more cortisol than men do, women make far more oxytocin as a way of buffering stress. Levels of this powerful hormone rise when we kiss or hug, have sex, give birth, or breast-feed. Since women have boatloads more estrogen than men, and estrogen enhances the bonding effects of oxytocin, women are more likely than men to opt for the tend-and- befriend response. Certainly women also run or take flight when a threat is severe, but taking off is not the first or primary instinct, as it is with men. Marriage, Stress, and Cortisol Marriage favors men more than women when it comes to health. Among dual-earning couples with at least one kid under the age of five, working longer hours, for instance, raises the total daily levels of cortisol similarly in men and women.

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It may be begun two weeks before the menses should next appear generic bystolic 5 mg with amex heart attack 9gag, if one period has passed cheap bystolic 2.5 mg overnight delivery blood pressure 58 over 38, and given every four hours in cold water, until a day or two before the expected time, when it can again be given in hot water. More recently, I have used it in conjunction with one or two of the other uterine remedies, carefully selected, in all forms of menstrual suppression, except in feeble and anemic patients, and have, found it efficient and readily controllable. It acts promptly upon the skin and kidneys and seems to be to a certain extent antispasmodic, as in hystero-epilepsy, or epilepsy depending upon suppression of the menses, it relieves the paroxysms and reduces the number of the attacks. Goss recommended it when there was urinary suppression from cold and in retention with lack of power in the bladder. In certain forms of flatulent colic, when the pains are sharp and lancinating, intermittent, and of a severe griping character, it is curative. Physiological Action—Given in large doses polymnia acts as an emeto- cathartic, producing painful evacuations, with severe emesis, and if pushed produces gastro-intestinal inflammation, dizziness, convulsions and even death. Specific Symptomatology—It is indicated in conditions of inactivity of the organs, with passive fullness of the circulation of the parts, or of surrounding tissues which may be of a sodden inelastic character. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 359 Inactive engorgements, or stagnations of the circulation, are general conditions pointing to the use of this agent. Scudder gave as its indications full, flabby, sallow tissues, impaired circulation, glandular enlargement and other impaired functions from lack of tone. Therapy—The older writers of our school lauded this remedy as of much importance in rheumatism. Others spoke of it favorably in the same class of cases in which phytolacca is used. Pruitt used it in the form of an ointment, in inflammation of the mammary glands, and other glandular inflammations, especially if abscesses had formed. The specific influence of the remedy, however, as agreed by all writers, is upon enlargement of the spleen. This gland is influenced in chronic malarial conditions, in scrofulous diseases and in tubercular difficulties. It is upon the malarial form of splenic enlargement that it acts to the best advantage. It should be used freely internally, and externally the hot infusion must be applied. A chronically enlarged inactive engorged liver, with tenderness on pressure, is quickly and satisfactorily cured by it. A womb enlarged from subinvolution or other hypertrophy, yields satisfactorily to its influence. It has been used in mastitis or “caked breast” so-called, to excellent advantage, but its prolonged use may suppress the secretion of milk. It is an active stimulant to the removal of waste in all the conditions mentioned. The removal of chronic inflammatory deposits stimulates the capillary circulation to better action and relieves the aching pain and soreness common to such conditions. It has been praised most highly in the treatment of rheumatism, lumbago, myalgia, and other painful conditions dependent upon the imperfect removal of the products of retrograde metamorphosis. It is a remedy of much value in scrofulous conditions with glandular indurations or abscess. Its external application has relieved many cases of severe spinal irritation, especially if present with the general conditions named above as indicating the use of this agent. Scudder gave the following list of disorders, in which it had a direct Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 360 influence: Chronic enlargement of the spleen, chronic enlargement of the liver, chronic hypertrophy of the cervix uteri, chronic gastritis, chronic metritis with hypertrophy, uterine subinvolution and general glandular enlargement. The remedy, no doubt, stands at the head of spleen remedies, but it is not used as it should be, the younger physicians paying but little attention to it. Felter says, when dyspepsia depends upon a sluggish circulation in the gastric and hepatic arteries, and is attended with full, heavy, burning sensation, in the parts supplied by these arteries, this is our remedy. A common cause of failure in the treatment of chronic diseases is the lack of persistency.


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