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Overall discount keftab 750 mg without prescription, people in Northern and Western Europe are thinner than Eastern and Southern Europe and women are more likely to be obese than men cheap keftab 375mg with visa. Physical problems Obesity has been associated with cardiovascular disease, diabetes, joint trauma, back pain, cancer, hypertension and mortality (e. The effects of obesity are related to where the excess weight is carried; weight stored in the upper body, particularly in the abdomen, is more detrimental to health than weight carried on the lower body. It is interesting to note that although men are more likely than women to store fat on their upper bodies, and are therefore more at risk if obese, women are more concerned about weight than men and most treatment studies examine women. It has been suggested that most problems seem to be associated with severe obesity and weights in the top 10 per cent (Wooley and Wooley 1984). Psychological problems Research has examined the relationship between psychological problems and obesity. The contemporary cultural obsession with thinness, the aversion to fat found in both adults and children and the attribution of blame to the obese may promote low self- esteem and poor self-image in those individuals who do not conform to the stereo- typically attractive thin image. Furthermore, Hopkinson and Bland (1982) reported that one-fifth of their sample of obese subjects, also waiting for surgical treatment, reported having at least one period of clinical depression requiring treatment. However, it is possible that depressed obese individuals are more likely to seek treatment for their obesity than those who are not depressed and that there may be many obese individuals who are quite happy and therefore do not come into contact with health professionals. Therefore, although some obese people may be depressed there is no consistent support for a simple relationship between body size and psychological problems. The theories relating to the causes of obesity include both physiological theories and behavioural theories. Physiological theories Several physiological theories describe the possible causes of obesity. Genetic theories Size appears to run in families and the probability that a child will be overweight is related to the parents’ weight. For example, having one obese parent results in a 40 per cent chance of producing an obese child and having two obese parents results in an 80 per cent chance. In contrast, the probability that thin parents will produce overweight children is very small, about 7 per cent (Garn et al. However, parents and children share both environment and genetic constitution, so this likeness could be due to either factor. Twin studies Twin studies have examined the weight of identical twins reared apart, who have identical genes but different environments. Studies have also examined the weights of non-identical twins reared together, who have different genes but similar environments. The results show that the identical twins reared apart are more similar in weight than non-identical twins reared together. However, the role of genetics appears to be greater in lighter twin pairs than in heavier pairs. Such studies compare the adoptees’ weight with both their adoptive parents and their biological parents. The results showed a strong relationship between the weight class of the adoptee (thin, median weight, overweight, obese) and their biological parents’ weight class but no relationship with their adoptee parents’ weight class. This relationship suggests a major role for genetics and was also found across the whole range of body weight. Interestingly, the relationship to biological mother’s weight was greater than the relationship with the biological father’s weight. Research also suggests that the primary distribution of this weight (upper versus lower body) is also inherited (Bouchard et al. Metabolic rate, the number of fat cells and appetite regulation may be three factors influenced by genetics. Metabolic rate theory The body uses energy for exercise and physical activity and to carry out all the chemical and biological processes that are essential to being alive (e. The rate of this energy use is called the ‘resting metabolic rate’, which has been found to be highly heritable (Bouchard et al. It has been argued that lower metabolic rates may be associated with obesity as people with lower metabolic rates burn up less calories when they are resting and therefore require less food intake to carry on living. A group in Phoenix assessed the metabolic rates of 126 Pima Indians by monitoring their breathing for a 40-minute period. The study was carried out using Pima Indians because they have an abnormally high rate of obesity (about 80–85 per cent) and were considered an interesting population. The subjects remained still and the levels of oxygen consumed and carbon dioxide produced was measured. The researchers then followed any changes in weight and metabolic rate for a four-year period and found that the people who gained a substantial amount of weight were the ones with the lowest metabolic rates at the beginning of the study. In a further study, 95 subjects spent 24 hours in a respiratory chamber and the amount of energy used was measured.

The formation of acetylides and alkynides (alkynyl Grignard reagent and alkylnyllithium) are important reactions of terminal alkynes (see Section 4 purchase 500 mg keftab otc. Acetylides and alkynides undergo nucleophilic addition with aldehydes and ketones to produce alcohols (see Section 5 keftab 500mg fast delivery. H O+ Y = H or R 3 Y = H or R Aldehyde or ketone M+ = Na, Li Y Aldehyde or ketone Alcohol They react with alkyl halides to give internal alkynes (see Section 5. Any terminal alkyne can be converted to acetylide and alkynide, and then alkylated by the reaction with alkyl halide to produce an internal alkyne. In these reactions, the triple bonds are available for electrophilic additions to a number of other functional groups. Therefore, in order to understand the chemical nature, physical properties, stability, pharmacological actions and toxicities of a majority of drug molecules, the knowledge of aromatic chemistry is extremely important. Before we look into the specific examples of various drugs that belong to this aromatic class, let us try to understand what aromaticity really is. How- ever, there are a number of other nonbenezenoid compounds that can be classified as aromatic compounds. He isolated benzene from a compressed illuminating gas that had been made by pyrolysing whale oil. In 1834, Eilhardt Mitscherlich synthesized benzene by heating benzoic acid with calcium oxide. In the late 19th century, August Kekule´ first noticed that all early aromatic compounds contain a six- carbon unit that is retained through most chemical transformation and degradation. Benzene If n ¼ 1, we have 4 Â 1 þ 2 ¼ 6, which means that any compound contain- ing a total number of six p electrons is an aromatic compound. In the above structure of benzene, there are three double bonds and six p electrons, and it is a planar molecule. Naphthalene Anthracene Nonbenzenoids These compounds generally have two or more rings fused together, but none of the rings is a benzene structure, and they conform to Huckel’s¨ rule, i. Macrocyclic These are monocyclic nonbenzene structures, and the ring sizes are quite big. There is an adequate number of double bonds and p electrons to conform to Huckel’s¨ rule; e. N N H Pyridine Pyrrole Pyridine has p electron structure similar to that of benzene. Each of the five 2 sp -hybridized carbons has a p orbital perpendicular to the plane of the ring. H H Structure of pydridine with p orbitals The situation in pyrrole is slightly different. It has four sp -hybridized carbons, each of which has a p orbital perpendicular to the ring and 2 contributes one p electron. The nitrogen atom is also sp -hybridized and its lone pair electrons occupies a p orbital. Therefore, there is a total of six p electrons, which makes pyrrole an aromatic compound. Just a few examples of pharmaceutically important aromatic compounds are cited here. Aspirin, a well known non-narcotic analgesic and antipyretic drug, is a classic example of a pharmaceutically important benzene derivative. Morphine, an aromatic alkaloid, is a narcotic (habit-forming) analgesic that is used extensively for the management of post-operative pain. Aromatic compound valium is prescribed as a tranquillizer and ibuprofen as an anti-inflamma- tory, and sulpha drugs, e. Taxol, one of the best selling anticancer drugs of modern time, also belongs to the class of aromatic compounds. Accord- ing to his proposals, in benzene (a) all six carbon atoms are in a ring; (b) all carbon atoms are bonded to each other by alternating single and double bonds; (c) one hydrogen atom is attached to each carbon atom; (d) all hydrogen atoms are equivalent. H H H H H H Kekulé structure of benzene Limitations of Kekule´ structure The Kekule´ structure predicts that there should be two different 1,2-dibromobenzenes. Later, this proposal was proved to be incorrect, because no such equilibrium exists! Br Br Br Br Two different 1,2-dibromobenzenes as suggested by Kekulé Benzene cannot be represented accurately by either individual Kekule´ structure, and does not oscillate back and forth between two. The resonance explanation of the structure of benzene The resonance theory can be applied successfully to explain the structure of benzene. According to this theory (a) resonance forms are imaginary, not real; (b) resonance structures differ only in the positions of their electrons; (c) different resonance forms do not have to be equivalent; (d) the more resonance structures there are, the more stable the molecule is; (e) whenever it is possible to draw two or more resonance structures of a molecule, none of the structures will be in complete agreement with the compound’s chemical and physical properties; (f) the actual molecule or ion is better represented by a hybrid of these structures; (g) whenever an equivalent resonance structure can be drawn for a molecule, the molecule (or hybrid) is much more stable than any of the resonance structures could be individually if they could exist. If we consider the Kekule´ structure of benzene, it is evident that the two proposed structures differ only in the positions of the electrons. Therefore, instead of being two separate molecules in equilibrium, they are indeed two resonance contributors to a picture of the real molecule of benzene.

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Note cultural 500 mg keftab with visa, social keftab 250mg generic, ethnic, racial, and religious factors that may contribute to conflicts regarding variant sexual prac- tices. Client may be unaware of the influence these factors exert in creating feelings of discomfort, shame, and guilt regarding sexual attitudes and behavior. The client is more likely to share this information if he or she does not fear being judged by the nurse. Assist therapist in plan of behavior modification to help cli- ent who desires to decrease variant sexual behaviors. Indi- viduals with paraphilias are treated by specialists who have Sexual and Gender Identity Disorders ● 211 experience in modifying variant sexual behaviors. Nurses can intervene by providing assistance with implementation of the plan for behavior modification. If altered sexuality patterns are related to illness or medi- cal treatment, provide information to client and partner re- garding the correlation between the illness and the sexual alteration. Explain possible modifications in usual sexual patterns that client and partner may try in an effort to achieve a satisfying sexual experience in spite of the limi- tation. Client and partner may be unaware of alternate possibilities for achieving sexual satisfaction, or anxiety associated with the limitation may interfere with rational problem solving. Explain to client that sexuality is a normal human response and does not relate exclusively to the sex organs or sexual be- havior. Sexuality involves complex interrelationships among one’s self-concept, body image, personal history, and family and cultural influences; and all interactions with others. If client feels “abnormal” or very unlike everyone else, the self-concept is likely to be very low—he or she may even feel worthless. To increase the client’s feelings of self-worth and desire to change behavior, help him or her to see that even though the behavior is variant, feelings and motivations are common. Client is able to verbalize fears about abnormality and inap- propriateness of sexual behaviors. Client expresses desire to change variant sexual behavior and cooperates with plan of behavior modification. Client and partner verbalize modifications in sexual activi- ties in response to limitations imposed by illness or medical treatment. Client expresses satisfaction with own sexuality pattern or a satisfying sexual relationship with another. Gender Identity Disorders Gender identity is the sense of knowing to which gender one belongs—that is, the awareness of one’s masculinity or femininity. Gender identity disorders occur when there is incongruity be- tween anatomic sex and gender identity. An individual with gen- der identity disorder has an intense desire to be, or insists that he or she is of, the other gender. Intervention with adolescents and adults with gender identity disorder is difficult. Adolescents commonly act out and rarely have the motivation required to alter their cross-gender roles. Treatment of children with the disorder is aimed at helping them to become more comfortable with their assigned gender and to avoid the possible development of gender dissatisfaction in adulthood. Studies of genetics and physiological alterations have been conducted in an attempt to determine whether or not a biological predisposition to gender identity disorder exists. Family Dynamics: It appears that family dynamics plays the most influential role in the etiology of gender disor- ders. Sadock and Sadock (2007) state, “Children develop a gender identity consonant with their sex of rearing (also known as assigned sex). Although “temperament” may play a role with certain behavioral characteristics being present at birth, mothers usually foster a child’s pride in their gender. Sadock and Sadock (2007) state: The father’s role is also important in the early years, and his presence normally helps the separation- individuation process. For a girl, the father is normally the prototype of future love objects; for a boy, the father is a model for male identification” (p. This theory suggests that gen- der identity problems begin during the struggle of the Oedipal/Electra conflict. Problems may reflect both real family events and those created in the child’s imagination. These conflicts, whether real or imagined, interfere with the child’s loving of the opposite-gender parent and iden- tifying with the same-gender parent, and ultimately with normal gender identity. Strong desire to participate only in the stereotypical games and pastimes of the opposite gender. Stated conviction that one has the typical feelings and reac- tions of the opposite gender. Persistent discomfort with or sense of inappropriateness in the assigned gender role. Common Nursing Diagnoses and Interventions for Gender Identity Disorder (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice.

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Hot and cold stone massage concerned also with an individual’s posture and the uses rock formed by volcanic and sedimentary condition of his or her intestinal tract order 125 mg keftab with mastercard. More infor- action to manipulate the muscles and induce mation is available in the book Health through Inner relaxation and healing buy keftab 125mg visa. These oils are used to affect the way you feel, such as to deepen relaxation, rid the mind of worry, meditation The art and science of quieting and or energize. Aromatherapy adds the air of luxury centering the mind and coordinating breathing for and pampering to a massage session. Before accept- the purpose of achieving deep relaxation and clar- ing such treatment, the client should be sure the ity of thinking. Check with a physician before related to one’s emotional or mental condition and having a massage treatment after recent surgery moods. Fourteen pathways uncommon for people with little or no formal edu- go to and from the hands and feet to the torso and 84 mesmerism head. Twelve main bilateral meridians correspond to beings possess a life force or energy beyond the the 12 major organs—liver, spleen, heart, stomach, physical constitution, and that energy may become kidneys, lungs, etc. Six meridians pertain to the blad- blocked or unbalanced in some way, causing illness der, gallbladder, stomach, small intestine, and large or injury or dysfunction. Moreover, the blockage intestine, and the Triple Burner (which regulates may be either physical or emotional, current or his- overall body temperature) is related to the trans- torical, in origin. Chinese practition- Acting as a catalyst for the client, the meta- ers believe imbalances, blockages, or disharmonies morphic practitioner uses a light touch on points along points of any of the meridians cause symptoms known as the spinal reflexes in the feet, hands, of illness. The Metamorphic Technique is not a therapy or a treatment, since it is not concerned mesmerism The technique of “animal magnet- with addressing specific symptoms or problems. It can be used alone or complement conventional or alternative medicine therapies. Metamorphic Technique An approach to self- No special training, abilities, or background are healing and personal development through elimi- needed in order to become a practitioner. Clients nating limited beliefs about one’s potential and who wish to transform their behavioral and emo- patterns both physical and emotional that cause tional patterns often seek the Metamorphic Tech- these beliefs. The recip- technique acts as a catalyst to this energy (also ient removes shoes and socks and may either sit or known as the life force), gently helping to trans- lie down. The practitioner uses a light touch on the form the negative patterns into positive ones. The Metamorphic Technique originated in the Metamorphic Technique practitioners work in a work of Robert St. John, a British naturopath and detached way: nonjudgmental, nonmanipulative, reflexologist. He then abilities, as well as in schools for children with developed the spinal reflexes approach in combi- learning difficulties, in hospitals, in prisons, and nation with the concept of innate self-healing abil- in practices that help people overcome addic- ity and eventually called the entire process tions, eating disorders, and stress-related condi- Metamporphosis, particularly because the changes tions. It is also used by pregnant women and experienced by clients appeared to be enduring. John during the 1970s, further devel- The Metamorphic Association offers these oped St. In 1979 he set up the Metamorphic Association, which was then registered as a charity • A unique tool for personal transformation. While other approaches often focus on particularly by syphilis, a venereal disease that removing energy blockages, the Metamorphic eventually destroys all the bodily systems. It does not consider people to be “blocked” or “broken” and in need of being mind-body connection The relationship between “fixed. The energy that was fatigue, exposure to environmental factors, and involved in creating the old patterns is released other general emotional conditions are manifested and can be used to create new patterns. Any changes that occur originate at the National Institute of Mental Health, Candace entirely from within the recipient. The practitioner simply acts as a catalyst in tides, encouraged research on neuropeptides. Alternative nor diagnosis, nor any need to discuss personal and integrative medicine modalities have embraced problems or medical history. It func- tions as a network of people who support each molecular nutrition The application of biochemi- other in learning, sharing, exploring, practicing, cal and physiological approaches to the understand- promoting and teaching the Metamorphic Tech- ing of nutrient function and metabolism in systems nique. As members of the association, they have a ranging from the whole animal to the molecular common goal: “to promote good health and well- level. Nutrition is a natural science that has a funda- being through awareness, understanding and use of mental biological basis. To study such processes and pathways miasm In homeopathic medicine, an underlying requires a critical knowledge of biochemistry and pattern of dysfunction that creates and maintains physiology combined with a fundamental back- chronic disease processes and their recurrences.

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