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Cultural considerations in the assessment and treatment of religious and spiritual problems proscar 5mg without prescription. Religious commitment and health status: a review of the research and implications for family medicine buy proscar 5 mg amex. J Fam Pract 1991; 32:210–13 Religious involvement proscar 5mg line, spirituality and medicine 241 10 buy 5 mg proscar amex. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Patient attitudes regarding physician inquiry into spiritual and religious issues buy proscar 5 mg on-line. Experiments on distant intercessory prayer: God, science, and the lesson of Massah. Should academic medical centers conduct clinical trials of the efficacy of intercessory prayer? Systematic analysis of research on religious variables in four major psychiatric journals, 1978–1982. A systematic review of research on religion in four major psychiatric journals: 1991–1995. A systematic analysis of religious variables in The Journal of Family Practice, 1976–1986. Research on religious variables in five major adolescent research journals: 1992 to 1996. An analysis of research on religious and spiritual variables in three major mental health nursing journals, 1991–1995. Fatal arteriosclerotic heart disease, water hardness at home, and socioeconomic characteristics. Social networks, host resistance, and mortality: a nine-year followup study of Alameda County residents. The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study. Psychosocial predictors of mortality among the elderly poor: the role of religion, well-being, and social contacts. Population based study of social and productive activities as predictors of survival among elderly Americans. Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study. Factors predictive of long-term coronary heart disease mortality among 10,059 male Israeli civil servants and municipal employees: a 23-year mortality follow-up in the Israeli Ischemic Heart Disease Study. Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly. The relation between religiosity, selected health behaviors, and blood pressure among adult females. Relationship of religiosity to wellness and other health-related behaviors and outcomes. Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Ann Behav Med 2001; 23:68–74 Religious involvement, spirituality and medicine 243 58. Religion among disabled and nondisabled persons II: attendance at religious services as a predictor of the course of disability. Factors influencing views of patients with gynecologic cancer about end-of-life decisions. The Faith Factor: an Annotated Bibliography of Clinical Research on Spiritual Subjects, vol 1. Religiosity as a protective or prognostic factor of depression in later life; results from a community survey in The Netherlands. Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. Religion and anxiety disorder: an examination and comparison of associations in young, middle-aged, and elderly adults. Matching Alcoholism Treatments to Client Heterogeneity: Project MATCH posttreatment drinking outcomes. Religious involvement and cigarette smoking in young adults: the CARDIA study (Coronary Artery Risk Development in Young Adults study).

Or- constant order proscar 5mg overnight delivery, although the organism absorbs gans such as the digestive tract and liver ab- nutrients from it and excretes waste into it discount 5mg proscar with visa. In sorb nutrients and make them available by 2 spite of its simple structure order proscar 5 mg line, the unicellular or- processing buy 5 mg proscar, metabolizing and distributing! Unicellular organism in the constant external environment of the primordial sea Substance absorption Primordial Signal reception and excretion sea Heat Ion exchange Genome Digestion Water O2 Exchange Motility of gases CO2 Excretion B purchase proscar 5 mg line. Maintenance of a stable internal environment in humans Integrationthrough External signals nervous system and hormones O2 CO2 Emissionof Exchange heat Internal of gases (water, salt) signals Behavior Regulation Lungs Blood Extra- Skin cellular Interstice space Intracellular space Uptake of nutrients, water, salts, etc. Kidney Distribution Excretion of excess – water Waste and – salts toxins Liver – acids Digestive Excretionof 33 tract waste and toxins Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. The lung is re- Although behavioral science, sociology, and sponsible for the exchange of gases (O2 intake, psychology are disciplines that border on CO2 elimination), the liver and kidney for the physiology, true bridges between them and excretion of waste and foreign substances, and physiology have been established only in ex- the skin for the release of heat. In order to have useful cooperation between The specialization of cells and organs for the specialized organs of the body, their func- specific tasks naturally requires integration, tions must be adjusted to meet specific needs. Control implies that a humoral transfer of information (hormones), controlled variable such as the blood pressure and transmission of electrical signals in the is subject to selective external modification, nervous system, to name a few examples. Because many other factors and disposal and thereby maintain a stable in- also affect the blood pressure and heart rate, ternal environment, even under conditions of the controlled variable can only be kept con- extremely high demand and stress. Moreover, stant by continuously measuring the current they control and regulate functions that en- blood pressure, comparing it with the refer- suresurvivalinthesenseofpreservationofthe ence signal (set point), and continuously cor- species. If the blood pressure clude not only the timely development of re- drops—due, for example, to rapidly standing productive organs and the availability of fertil- up from a recumbent position—the heart rate izable gametes at sexual maturity, but also the will increase until the blood pressure has been control of erection, ejaculation, fertilization, reasonably adjusted. Others include the coordination has risen above a certain limit, the heart rate of functions in the mother and fetus during willdecreaseagainandthebloodpressurewill pregnancy and regulation of the birth process normalize. It consists of a controller signals from peripheral sensors (single with a programmed set-point value (target sensory cells or sensory organs), activates out- value) and control elements (effectors) that can wardly directed effectors (e. The system also includes sensors that continu- The CNS is the focus of attention when study- ously measure the actual value of the con- inghumanoranimalbehavior. Ithelpsustolo- trolled variable of interest and report it (feed- cate food and water and protects us from heat back)tothecontroller,whichcomparestheac- orcold. Thecentralnervoussystemalsoplaysa tual value of the controlled variable with the role in partner selection, concern for offspring set-point value and makes the necessary ad- evenlongaftertheirbirth,andintegrationinto justments if disturbance-related discrepancies social systems. The control system operates development, expression, and processing of eitherfromwithintheorganitself(autoregula- emotions such as desire, listlessness, curiosity, tion) or via a superordinate organ such as the wishfulness, happiness, anger, wrath, and central nervous system or hormone glands. Control circuit Prescribed Set point value Actual value set point Controller = set point? Negative feedback Control signal Actual value Control element 1 Sensor Control element 2 Control element n Controlled 1 system Control circuit: principle Disturbance Actual pressure Set point = set point? Autonomic nervous system Circulatory centers Nerve IX Nerve X Presso- Arterioles sensors Heart rate Venous return Peripheral resistance Blood pressure 2 Control circuit: blood pressure Orthostasis etc. First, Withinthebody,thesetpointisrarelyinvaria- sensors with differential characteristics (D ble,butcanbe“shifted”whenrequirementsof sensors) ensure that the intensity of the sensor higher priority make such a change necessary. Second, feedforward nominal and actual values, thus leading to the controlensuresthatinformationregardingthe activation of regulatory elements (! Feedfor- bance variables), this is called servocontrol or ward control can be explained by example of servomechanism. The disadvantage of such as blood pressure, cellular pH, muscle having only D sensors in the control circuit can length, body weight and the plasma glucose be demonstrated by example of arterial pres- concentration, the body also regulates com- sosensors (=pressoreceptors) in acute blood plex sequences of events such as fertilization, pressure regulation. Very slow but steady pregnancy, growth and organ differentiation, changes, as observed in the development of as well as sensory stimulus processing and the arterial hypertension, then escape regulation. Theregu- hypertensive patient will even cause a coun- latory process may take parts of a second (e. The sudden emergence of a disturbance varia- ble causes larger deviations that quickly nor- malize in a stable control circuit (! The latter is true, for example, for the blood glucose concentration, which nearly doubles after meals. This type of regulation obviously functions only to prevent extreme rises and falls (e. More pre- cise maintenance of the controlled variable re- quires a higher level of regulatory sensitivity 6 (high amplification factor). However, this ex- Despopoulos, Color Atlas of Physiology © 2003 Thieme All rights reserved. Control circuit response to disturbance or set point (SP) deviation SP Controller SP Controller SP Controller Sensor Sensor Sensor Controlled Controlled Controlled system Disturbance system Disturbance system Disturb- ance Set point Actual value Time Time Time 1 Stable control 2 Strong disturbance 3 Large set point shift E.

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The hope Weakness of these muscle groups usually cause problems is that the cells in that area will not die off purchase 5 mg proscar with amex. Demographics Another symptom of ALS that usually occurs after Amyotrophic lateral sclerosis affects anyone and initial symptoms appear is persistent muscle twitching both men and women are at equal risk buy generic proscar 5 mg line. Fasciculation is almost never the first any age discount proscar 5 mg on line, and the odds of developing it increase with age generic 5mg proscar with mastercard. A As the disease progresses the respiratory muscles person only needs to inherit a defective gene from one (breathing muscles) weaken buy proscar 5mg line, resulting in increased diffi- parent to cause the disease. The potential for lung infection increases Signs and symptoms and can cause death. Many patients find it more comfort- The disease starts slowly, affecting just one limb, able and extend their lives when assisted by ventilators at such as the hands or feet, and steadily progresses to more this stage of the disease. One way to accomplish feedback with others is ishment they require, they begin to thin and deteriorate. Blinking is one mode that GALE ENCYCLOPEDIA OF GENETIC DISORDERS 81 patients of amyotrophic lateral sclerosis will be forced to the disease, and is vital for family members as well as utilize, in order to continue communication. As the disease progresses, victims gradually lose the Although there are no set treatments for ALS there use of their feet, hand, leg, and neck muscles, and paral- are still many special considerations that can assist in the ysis results in affected muscle groups. Sexual dys- cal therapy program, providing a wheelchair or walker, function is not affected. Breathing will become increas- assistance when bathing, and suction machines to help ingly difficult and the patients of ALS may decide to evacuate accumulated secretions all help the ALS patient. Researchers have developed a drug approved by the Diagnosis Food and Drug Administration (FDA) called Rilutek (riluzole). There is no one set way in that it appears to extend the life of ALS patients by to test for the disease. Electro diagnostic tests such as elec- Another drug, Myotrophin (somatomedin C), tromyography (EMG) and nerve conduction velocity appears to prevent neuron loss and enhance neuron gen- (NCV) are used to help diagnose ALS. If the person involved is young is suspected since it is a fatal neurological disease. After and the initial symptoms appear in the limbs, the disease a complete medical exam and family history check has tends to develop more slowly. Improved medical care has been administered, other tests such as a CT (computed prolonged the lives of ALS patients and shows promise tomography) scan may be done to continue ruling out for more effective treatments in the future. Many symptoms mimic ALS such as tumors of the skull base or upper cervical spinal cord, Resources spinal arthritis, thyroid disease, lead poisoning, and BOOKS severe vitamin deficiency. ORGANIZATIONS Moderate activities are recommended in the early Association of America (ALSA). Androgens—A group of steroid hormones that stu- Laith Farid Gulli, MD mulate the development of male sex organs and Brian Veillette, BS male secondary sexual characteristics. Chromosome—A microscopic thread-like struc- ture found within each cell of the body and con- sists of a complex of proteins and DNA. IAndrogen insensitivity Changes in either the total number of chromo- syndrome somes or their shape and size (structure) may lead to physical or mental abnormalities. Definition Mullerian ducts—Structures in the embryo that Androgen insensitivity syndrome is a genetic condi- develop into the fallopian tubes, the uterus, the tion where affected people have male chromosomes and cervix and the upper vagina in females. The external genitals, however, Wolffian ducts—Structures in the embryo that have mild to complete feminization. Description Normal sexual development dihydrotestosterone, the external genitals are not mas- In normal development, the chromosome sex deter- culinized and become female. Studies have shown that an mines the gonadal sex, which in turns determines the ovary is not required for the formation of the internal phenotypic sex. The chromosome sex is determined at female structures or the feminization of the genitals. If a conception; a male has the sex chromosome pair XY and testicle is not present, the development of the embryo a female has the chromosome pair XX. The presence 46,XY chromosomes, testicles, and male internal struc- of the Y chromosome in the male directs the undifferen- tures and genitals. Androgen insensitivity syndrome In males, the phenotypic sex, including the internal male structures and the external male genitalia, arises as Androgen insensitivity syndrome (AIS), also known as testicular feminization, is one of the most common a result of the hormones secreted from the testicles.

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The although the presence of food interferes with absorption prolonged half-life and protein binding and the use of and part of the dose is destroyed because of the relative an abbreviated one-time dose of azithromycin appear 47 Tetracyclines discount 5mg proscar with amex, Chloramphenicol generic proscar 5 mg with visa, Macrolides discount proscar 5 mg visa, and Lincosamides 549 to be extremely beneficial in the treatment of sexually levels can be obtained 1 hour after intravenous admin- transmitted diseases proscar 5 mg with amex. Therefore order 5 mg proscar fast delivery, bone and joint infec- The incidence of side effects associated with erythro- tions caused by susceptible organisms respond well to mycin therapy is very low. These drugs also concen- with nausea, diarrhea, and abdominal pain are reported trate within phagocytic cells, which may offer a thera- to occur more commonly when the propionate and es- peutic advantage. If renal function is impaired, the amount of lasts longer than 10 days or repeated courses are pre- drug excreted in the feces will be increased. The hepatitis is characterized by fever, enlarged and tender liver, hyperbilirubinemia, dark urine, Clinical Uses eosinophilia, elevated serum bilirubin, and elevated transaminase 1evels. Hepatitis has been associated with Clindamycin is highly active against staphylococci and the estolate salt of erythromycin but not with other for- streptococci other than enterococci. However, the adverse reaction of within hours in a patient who has had such a reaction in pseudomembranous colitis has limited its use to indi- the past. The hepatitis is believed to be the result of viduals who are unable to tolerate other antibiotics and both a hepatotoxic effect and a hypersensitivity reac- to the treatment of penicillin-resistant anaerobic bacte- tion; this latter effect is reversible on withdrawal of the rial infections. Erythromycin and derivatives induce hepatic mi- topically against Corynebacterium acnes in patients with crosomal enzymes and interfere with the actions of var- recalcitrant cystic facial acne who cannot tolerate tetra- ious drugs, including theophylline and carbamazepine. Precautions should be given to all patients us- ing the topical preparations, since the development of colitis is possible. LINCOSAMIDES Both clindamycin and choramphenicol have excel- lent activity against anaerobic bacteria but have poten- tially life-threatening adverse reactions and should not Mechanism of Action be used without good justification. The lincosamide family of antibiotics includes lin- comycin (Lincocin) and clindamycin (Cleocin), both of Adverse Effects which inhibit protein synthesis. They bind to the 50S ri- bosomal subunit at a binding site close to or overlapping The major adverse reactions reported are hypersensi- the binding sites for chloramphenicol and erythromycin. The rash is usually itchy, mor- They block peptide bond formation by interference at billiform, and general. Lincomycin is no abdominal pain, nausea, and vomiting occurs infre- longer available for human use in the United States. It is important to differentiate between gastroin- Absorption, Distribution, Metabolism, testinal irritation and pseudomembranous colitis. In its and Excretion most extreme form, the colitis results in mucosal ulcer- Food in the stomach does not interfere with the absorp- ation and bleeding and infrequently may necessitate tion of either clindamycin or lincomycin. Which of the following best treats the initial stage 3 days the discoloration of his forearm begins to as- of Lyme disease in adults? Blood cultures (A) Penicillin V are positive in approximately 12 hours for gram- (B) Erythromycin positive cocci in chains. Wound cultures of the lacer- (C) Clarithromycin ation also grow similar organisms, and high-dose (D) Doxycycline penicillin G is prescribed. Chloramphenicol is no longer the treatment of (D) Clarithromycin choice for any bacterial infection because of the po- (E) Doxycycline tentially fatal chloramphenicol-induced bone mar- 4. An envelope that passed through the facility against the infections indicated in choices A, B, C, and was delivered to a governmental office was and D. Clarithromycin is one of the recommended an- working at the same facility be tested and receive timicrobials for use in combination with other an- prophylactic antimicrobial therapy. Although ciprofloxacin is the primary agent rec- lowing antibiotics is also recognized as being effec- ommended for prophylaxis against anthrax, doxycy- tive prophylactic therapy for potential anthrax ex- cline is an equally effective agent. This individual most likely has a group A strep- (D) Doxycycline tococcal infection due to a minor wound. Approximately 2 days later the group A streptococcal organisms are present, peni- laceration site becomes red and swollen. By this point his forearm is swollen and the Actually, the treatment of choice for this condition skin is light brown. Cultures of his wound and two is immediate and possibly repeated surgical de- blood cultures 15 minutes apart are obtained. The macrolides: Principles and Practice of Infectious Diseases (5th Erythromycin, clarithromycin, and azithromycin. Case Study The Dangers of Vacations 28-year-old white man was on vacation for 2 (A) Chloramphenicol Aweeks in northern Minnesota in July. Approximately 3 weeks after (D) Gentamicin returning from his vacation, a red macule–papule developed on his right anterior thigh. Doxycycline Several other similar lesions developed on his right is considered to have the best activity against Lyme leg and trunk.

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