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Resources include further readings purchase flexeril online from canada, "Focus on Research" boxes buy 15 mg flexeril mastercard, web links buy cheapest flexeril, sample essay questions, chapter overviews, PowerPoint slides and an instructor resource manual. Health Psychology: A Textbook is essential reading for all students and researchers of health psychology and for students of medicine, nursing and allied health courses. Thomas’s School of Medicine, University of London, where she carries out research into health-related behaviours and teaches health psychology to both medical and psychology students. Except for the quotation of short passages for the purposes of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher or a licence from the Copyright Licensing Agency Limited. In addition, they tended to be driven by examples rather than by theories or models which made them diﬃcult to turn into lectures (from my perspective) or to use for essays or revision (from my students perspective). I also wanted to emphasize theory and to write the book in a way that would be useful (‘easily plagiarized’ I often think! Aims of this new third edition This third edition started as a quick update but has ended up as a fairly major revision. Health psychologists sometimes refer to the indirect and direct pathways between psychology and health. The indirect pathway refers to the role of factors such as health related behaviours (smoking, drinking, eating, etc. To date this book has mostly reﬂected this indirect pathway with its emphasis on beliefs and a range of health behaviours. These chapters have always been the strongest and have presented the theories and research in greatest depth, probably reﬂecting my own research interests. In contrast, the direct pathway refers to the role of factors such as stress and pain and draws upon the more biologically minded literatures. The ﬁrst chapter (Chapter 10) examines models of stress, stress and changes in physi- ology and how stress is measured. It includes a review of the literature on whether stress does result in illness and describes research which has explored how this association might come about. This chapter also describes the role of coping, social support, control and personality in moderating the stress illness link. I have included more work on how psychological factors may exacerbate pain perception and have detailed the recent reviews of pain management and the interesting work on pain acceptance. The structure of the third edition Health psychology is an expanding area in terms of teaching, research and practice. Health psychology teaching occurs at both the undergraduate and postgraduate level and is experienced by both mainstream psychology students and those studying other health- related subjects. Undergraduates are often expected to produce research projects as part of their assessment, and academic staﬀ and research teams carry out research to develop and test theories and to explore new areas. Such research often feeds directly into practice, with intervention programmes aiming to change the factors identiﬁed by research. This book aims to provide a com- prehensive introduction to the main topics of health psychology. In addition, how these theories can be turned into practice will also be described. This book is now supported by a comprehen- sive website which includes teaching supports such as lectures and assessments. Health psychology focuses on the indirect pathway between psychology and health which emphasizes the role that beliefs and behaviours play in health and illness. The contents of the ﬁrst half of this book reﬂect this emphasis and illustrate how diﬀerent sets of beliefs relate to behaviours and how both these factors are associated with illness. Chapter 2 examines changes in the causes of death over the twentieth century and why this shift suggests an increasing role for beliefs and behaviours. The chapter then assesses theories of health beliefs and the models that have been developed to describe beliefs and predict behaviour. Chapter 3 examines beliefs individuals have about illness and Chapter 4 examines health professionals’ health beliefs in the context of doctor– patient communication. Chapters 5– 9 examine health-related behaviours and illustrate many of the theories and constructs which have been applied to speciﬁc behaviours. Chapter 5 describes theories of addictive behaviours and the factors that predict smoking and alcohol con- sumption. Chapter 6 examines theories of eating behaviour drawing upon develop- mental models, cognitive theories and the role of weight concern. Chapter 9 examines screening as a health behaviour and assesses the psychological factors that relate to whether or not someone attends for a health check and the psychological consequences of screening programmes. Health psychology also focuses on the direct pathway between psychology and health and this is the focus for the second half of the book. Chapter 10 examines research on stress in terms of its deﬁnition and measurement and Chapter 11 assesses the links between stress and illness via changes in both physiology and behaviour and the role of moderating variables. Chapter 12 focuses on pain and evaluates the psycho- logical factors in exacerbating pain perception and explores how psychological interven- tions can be used to reduce pain and encourage pain acceptance. Chapter 13 speciﬁcally examines the interrelationships between beliefs, behaviour and health using the example of placebo eﬀects. Chapter 16 explores the problems with measuring health status and the issues surrounding the measurement of quality of life. Finally, Chapter 17 examines some of the assumptions within health psychology that are described throughout the book. My thanks again go to my psychology and medical students and to my colleagues over the years for their comments and feedback. For this edition I am particularly grateful to Derek Johnston and Amanda Williams for pointing me in the right direction, to David Armstrong for conversation and cooking, to Cecilia Clementi for help with all the new references and for Harry and Ellie for being wonderful and for going to bed on time. Take advantage of the study tools oﬀered to reinforce the material you have read in the text, and to develop your knowledge of Health Psychology in a fun and eﬀective way. Study Skills Open University Press publishes guides to study, research and exam skills, to help under- graduate and postgraduate students through their university studies. Get a £2 discount oﬀ these titles by entering the promotional code app when ordering online at www. The chapter highlights differences between health psychology and the biomedical model and examines the kinds of questions asked by health psychologists. Then the possible future of health psychology in terms of both clinical health psychology and becoming a professional health psychologist is discussed. Finally, this chapter outlines the aims of the textbook and describes how the book is structured. This chapter covers: ➧ The background to health psychology ➧ What is the biomedical model? Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution.
Because it is much easier to retrieve words by their first letter than by their third cheap 15mg flexeril mastercard, we may incorrectly guess that there are more words that begin with “R cheap flexeril online visa,‖ even though there are in fact more words that have “R‖ as the third letter buy 15mg flexeril with mastercard. We may think that our friends are nice people, because we see and remember them primarily when they are around us (their friends, who they are, of course, nice to). And the traffic might seem worse in our own neighborhood than we think it is in other places, in part because nearby traffic jams are more easily retrieved than are traffic jams that occur somewhere else. Salience and Cognitive Accessibility Still another potential for bias in memory occurs because we are more likely to attend to, and thus make use of and remember, some information more than other information. For one, we tend to attend to and remember things that are highly salient, meaning that they attract our attention. Things that are unique, colorful, bright, moving, and unexpected are more salient  (McArthur & Post, 1977; Taylor & Fiske, 1978). In one relevant study, Loftus, Loftus, and  Messo (1987) showed people images of a customer walking up to a bank teller and pulling out either a pistol or a checkbook. By tracking eye movements, the researchers determined that people were more likely to look at the gun than at the checkbook, and that this reduced their ability to accurately identify the criminal in a lineup that was given later. The salience of the gun drew people‘s attention away from the face of the criminal. The salience of the stimuli in our social worlds has a big influence on our judgment, and in some cases may lead us to behave in ways that we might better not have. You checked Consumer Reports online and found that, although the players differed on many dimensions, including price, battery life, ability to share music, and so forth, the Zune was nevertheless rated significantly higher by owners than was the iPod. You tell her that you were thinking of buying a Zune, and she tells you that you are crazy. She says she knows someone who had one and it had a lot of problems—it didn‘t download music correctly, the battery died right after the warranty expired, and so forth—and that she would never buy one. If you think about this question logically, the information that you just got from your friend isn‘t really all that important. You now know the opinion of one more person, but that can‘t change the overall rating of the two machines very much. On the other hand, the information your friend gives you, and the chance to use her iPod, are highly salient. The information is right there in front of you, in your hand, whereas the statistical information from Consumer Reports is only in the form of a table that you saw on your computer. The outcome in cases such as this is that people frequently ignore the less salient but more important information, such as the likelihood that events occur across a large population (these statistics are known as base rates), in favor of the less important but nevertheless more salient information. People also vary in the schemas that they find important to use when judging others and when thinking about themselves. Cognitive accessibility refers tothe extent to which knowledge is activated in memory, and thus likely to be used in cognition and behavior. For instance, you probably know a person who is a golf nut (or fanatic of another sport). Because he loves golf, it is important to his self-concept, he sets many of his goals in terms of the sport, and he tends to think about things and people in terms of it (“if he plays golf, he must be a good person! Other people have highly accessible schemas about environmental issues, eating healthy food, or drinking really good coffee. When schemas are highly accessible, we are likely to use them to Attributed to Charles Stangor Saylor. Counterfactual Thinking In addition to influencing our judgments about ourselves and others, the ease with which we can retrieve potential experiences from memory can have an important effect on our own emotions. If we can easily imagine an outcome that is better than what actually happened, then we may experience sadness and disappointment; on the other hand, if we can easily imagine that a result might have been worse than what actually happened, we may be more likely to experience happiness and satisfaction. The tendency to think about and experience events according to “what might have been‖ is known ascounterfactual thinking (Kahneman & Miller, 1986; Roese,  2005). Imagine, for instance, that you were participating in an important contest, and you won the silver (second-place) medal. Certainly you would be happy that you won the silver medal, but wouldn‘t you also be thinking about what might have happened if you had been just a little bit better—you might have won the gold medal! If you were thinking about the counterfactuals (the “what might have beens‖) perhaps the idea of not getting any medal at all would have been highly accessible; you‘d be happy that you got the medal that you did get, rather than coming in fourth. They videotaped the athletes both as they learned that they had won a silver or a bronze medal and again as they were awarded the medal. Then the researchers showed these videos, without any sound, to raters who did not know which medal which athlete had won. In a follow-up study, raters watched interviews with many of these same athletes as they talked about their performance. The raters indicated what we would expect on the basis of counterfactual thinking—the silver medalists talked about their disappointments in having finished second rather than first, whereas the bronze medalists focused on how happy they were to have finished third rather than fourth. I really wanted to make it home when I got near the end of my journey; I would have been extremely disappointed if the car broke down only a few miles from my home. Perhaps you have noticed that once you get close to finishing something, you feel like you really need to get it done. Jurors who were asked to award monetary damages to others who had been in an accident offered them substantially more in compensation if they barely avoided injury than they offered if the accident seemed inevitable (Miller, Turnbull, & McFarland,  1988). Psychology in Everyday Life: Cognitive Biases in the Real World Perhaps you are thinking that the kinds of errors that we have been talking about don‘t seem that important. After all, who really cares if we think there are more words that begin with the letter ―R‖ than there actually are, or if bronze medal winners are happier than the silver medalists? But it turns out that what seem to be relatively small cognitive biases on the surface can have profound consequences for people. Why would so many people continue to purchase lottery tickets, buy risky investments in the stock market, or gamble their money in casinos when the likelihood of them ever winning is so low? One possibility is that they are victims of salience; they focus their attention on the salient likelihood of a big win, forgetting that the base rate of the event occurring is very low. The belief in astrology, which all scientific evidence suggests is not accurate, is probably driven in part by the salience of the occasions when the predictions are correct. People may also take more care to prepare for unlikely events than for more likely ones, because the unlikely ones are more salient. For instance, people may think that they are more likely to die from a terrorist attack or a homicide than they are from diabetes, stroke, or tuberculosis. And people are frequently more afraid of flying than driving, although the likelihood of dying in a car crash is hundreds of times greater than dying in a plane crash (more than 50,000 people are killed on U. Because people don‘t accurately calibrate their behaviors to match the true potential risks (e. Salience and accessibility also color how we perceive our social worlds, which may have a big influence on our behavior. For instance, people who watch a lot of violent television shows also view the world as more dangerous  (Doob & Macdonald, 1979), probably because violence becomes more cognitively accessible for them.
Action potential Ion exchange between intracellular and extracellular fluid creates transmembrane imbalances order discount flexeril online, enabling muscular (electrical) activity purchase flexeril with mastercard, hence action potential (Figure 21 flexeril 15 mg with amex. When electrical activity is absent, resting sinoatrial potential is about −90 millivolts (mv). The three main ions involved with action potential are ■ sodium ■ potassium ■ calcium Extracellular concentrations of about 140 mmol/litre of sodium and 4. Action potential changes along conduction pathways to ‘overpacing’ lower pacemakers. This lasts only milliseconds before resting charge of −90 mv (repolarisation) is restored. Action potential of pacemaker cells (sinoatrial node, atrioventricular node and conducting fibres) differs from other myocytes, reflecting the automaticity of pacemaker cells. This prevents cardiac muscle responding to further stimulus, thus ensuring coordinated contraction. Plateau time influences contractile strength of muscle fibres (which determines stroke volume). Hypercalcaemia increases contractility; calcium antagonists can reduce excitability. Catecholamines increase depolarisation (increase duration of phase 4) in pacemaker cells, hence causing tachycardia. Vagal stimulation (mediated through acetylcholine) slows depolarisation (decreases slope in phase 4) of pacemaker cells, causing bradycardia. Atrial/junctional dysrhythmias Sinus arrhythmia This occurs when inspiration increases intrathoracic pressure sufficiently to cause parasympathetic (vagal) stimulation, slowing sinoatrial rate; on expiration, the faster rate is restored. It occurs mainly in children and younger people; high ventilator tidal volumes may cause sinus arrhythmia. Bradycardic children should be given oxygen urgently (unless there are other obvious causes for bradycardia). Obvious causes should be removed, so that oxygen should be optimised (on avoiding oxygen toxicity, see Chapter 18). Drugs include ■ anticholinergics (atropine) block parasympathetic stimulation ■ sympathetic stimulants (adrenaline, isoprenaline). Severe refractory sinus bradycardia may necessitate pacing (temporary or permanent). Young children often have intrinsic (normal) rates exceeding 100 contractions/minute. Cardiac output is usually adequate with rates below 180 beats/min (bpm) provided venous return remains adequate, although rates above 140 bpm are usually treated. Tachycardia reduces diastolic time, and so reduces coronary artery filling time and left ventricular muscle oxygen supply, while increasing left ventricular workload and myocardial oxygen demand. Supraventricular tachycardia This severely compromises both cardiac output (rates of 160–250 (Cohn & Gilroy- Doohan 1996)) and myocardial oxygenation, usually necessitating treatment. Intensive care nursing 202 Ectopics Ectopic foci may be ■ atrial ■ junctional ■ ventricular Impulses may be premature (before expected impulses) or escape (expected complexes are absent, failing to overpace lower and slower foci, so ectopic impulses ‘escape’). Premature complexes may suppress underlying rhythms; escape rhythms are inherently slower than underlying sinus rhythm. Atrial ectopics These are premature electrical beats initiated in the atrial muscle outside the sinoatrial node. Treatment is usually initiated when there are more than six atrial ectopics per minute. P waves are absent, but ‘quivering’ may cause ‘f’ waves (Cohn & Gilroy-Doohan 1996)— fine, but visible, waves, suggesting some coordinated conduction and so good prognosis. Atrial flutter This is caused by macro re-entry circuits in the atrium (Creamer & Rowlands 1996), creating regular, but rapid, atrial impulses, P waves having distinctive saw tooth shapes (F waves). Atrial rate is often 300 (Creamer & Rowlands 1996), with regular atrioventricular block (usually 2:1). Increased atrioventricular conduction can cause palpitations, dyspnoea and potentially life- threatening tachycardias. Rapid atrial rates are normally blocked, so ventricular response remains normal, but any reduction in block causes supraventricular tachycardia. Cardioversion may restore stability, but curing the underlying problem necessitates ablation of aberrant pathways. Catheterisation and surgery share similar success rates, but catheterisation reduces length of stay, trauma and cost (Shih et al. Pacemaker rates slow as conduction pathways progress (‘lower is slower’); higher impulses normally overpace, lower impulses only escaping when higher impulses are absent. Intrinsic junctional rate is usually 40–60, although acceleration can occur (Cohn & Gilroy-Doohan 1996). Oedema from cardiac surgery often causes transient junctional rhythms (hence epicardial pacing wires). If bradycardia becomes symptomatic, treat as above (atropine, adrenaline, pacing). Formerly type 1 was named Mobitz type 1 or Wenkebach phenomenon; type 2 was called Mobitz type 2; these names, although technically obsolete, still persist in practice. Drugs used include: ■ atropine ■ isoprenaline (when unresponsive to atropine) If symptoms persist pacing may be needed. Intrinsic ventricular rates are slow (about 40 beats every minute); cardiac output is severely impaired, causing hypotension. Bundle branch block This is delayed partial intraventricular conduction (Figure 21. The Bundle of His divides into left and right branch bundles, the left branch further dividing between anterior and posterior fascicles. Ventricular dysrhythmias Ventricular ectopics These originate from ventricular foci outside normal conduction pathways, and so lack P waves and are conducted (slowly) from muscle fibre to muscle fibre. Ectopics originating near the ventricular apex are conducted downwards, giving positive complexes; those originating near the base have retrograde conduction through ventricular muscle, giving negative complexes. Complexes from a single focus (‘unifocaP) look alike; ectopics with different shapes originate from different foci (‘multifocal’). Treatment is usually initiated if it is ■ persistent (more than six ectopics every minute) ■ bigeminy/trigeminy ■ multifocal ■ occurring in vulnerable phases of electrical impulse conduction (R on T). Premature ventricular ectopics may be reversed by overpacing (Hillel & Thys 1994). Intensive care nursing 210 Bigeminy and trigeminy These are sinister extensions of ventricular ectopics, occurring regularly (Figure 21. Bigeminy is one ventricular ectopic every other complex; trigeminy is one ventricular ectopic every third complex. Rates vary from 100–250 (Cohn & Gilroy-Doohan 1996), usually nearer the upper end of this range.