By V. Khabir. McMurry University.

Separate cloths should be used for cleaning the toilet and wash hand basin to reduce the risk of spreading germs from the toilet to the wash hand basin cheap 100 mg penegra mastercard. Cleaning staff should inspect the toilets and hand washing facilities at regular intervals to ensure purchase penegra 100mg online; • The toilets and wash hand basins are in good working order (e order 50 mg penegra with amex. A checklist should be located in the toilets which is dated and signed at regular intervals discount penegra 100mg on line. Showers can act as a potential source of cross infection if they are not cleaned after use. Infections that are known to spread in showers include verruca (viral) and athlete’s foot (fungal). Shower heads need regular cleaning to prevent scaling and a build up of dirt which will impede fow Water fountains and other drinking outlets should not be located in the toilets. Water system maintenance Poorly maintained water systems can harbour bacteria including legionella that could cause infections so it is very important to maintain constant circulation in a water system. General points All toys (including those not currently in use) should be cleaned on a regular basis e. Toys that are visibly dirty or contaminated with blood or body fuids should be taken out of use immediately for cleaning or disposal. When purchasing toys choose ones that are easy to clean and disinfect (when necessary). Jigsaws, puzzles and toys that young pupils may be inclined to put in their mouths should be capable of being washed and disinfected. Disinfection Procedure In some situations toys/equipment may need to be disinfected following cleaning. If disinfection is required: • A chlorine releasing disinfectant should be used diluted to a concentration of 1,000ppm available chlorine (see Chapter 3). Waste Disposal The majority of waste produced in schools is non hazardous and can be disposed of in black plastic bags in the normal waste stream through the local authority. Disposal of Sharps Pupils who require injections may need to bring needles and syringes to school (e. However, some animals including exotic species such as reptiles, fsh or birds that are often kept as pets can be a source of human infection. There is no means of knowing which animals may be carrying infection, so one must act at all times on the basis that an animal might be infected. However, sensible precautions, such as effective hand washing, can reduce any risk of infection. The principal of the school should ensure that a competent person is responsible for any animals brought into the school and that there is no risk of contravening the relevant Health & Safety legislation. The following principles should underpin the management of pets in any school: • Only animals in good health should be allowed into a school. Farm and zoo visits Visits to farms and zoos have grown in popularity over recent years; they are considered to be both educational and an enjoyable leisure pastime. Such visits give pupils the chance to have contact with animals they otherwise might not see and also to understand where food comes from. There are many potential infection hazards (as there are with domestic pets) on open farms, including pet- and animal- farms, and zoos. It is important to remember that diseases affecting animals can sometimes be passed to humans. A number of germs acquired from animals can cause diarrhoea and/or vomiting – which is usually a mild or temporary illness. Infection is mainly acquired by eating contaminated material, sucking fngers that have been contaminated, or by eating without washing hands. Recommendations to Follow in Relation to Open Farm Visits: Before the Visit Before the visit, the organiser should make contact with the farm or zoo being visited to discuss visit arrangements and to ensure that adequate infection control measures are in place. The organiser should be satisfed that the pet farm/zoo is well managed and precautions are in place to reduce the risk of infection to visitors. The organiser should ensure that hand washing facilities are adequate, accessible to pupils, with running hot and cold water, liquid soap, disposable paper towels, clean towels or air dryers, and waste containers. They should also ensure that all supervisors understand the need to make sure the pupils wash, or are helped to, wash their hands after contact with animals. The school authorities should also contact their local Department of Public Health as further action may be necessary. Coli, available on the Health Protection Surveillance Centre’s website at http://www. The close contact in some sports can allow infections to spread by direct skin-to-skin contact, inhalation of infected droplets or aerosols, or injuries resulting in breaks to the skin which disrupt the body’s natural defence mechanism. Some sports activities involve closer and more frequent body-to-body contact with other players or contact with equipment and are associated with a higher risk of injury or trauma. Evidence to date suggests that the highest risk sports are full-contact martial arts, boxing, and wrestling. Terminology can vary and the defnitions applied in this guidance are as follows: • High-risk contact / collision sports – e. Infections of particular relevance to contact sports include skin infections, blood-borne virus infections, glandular fever and tetanus. Therefore all need to be educated about the necessary precautions and hygiene requirements. General Precautions for All Sports, Including High Risk Sports Pupils and teachers should: • Wash hands regularly with liquid soap. To minimise the risk of infection bars of soap should not be provided in communal shower / wash rooms. Sports such as boxing, wrestling and tae kwon do have the highest, although still extremely low, risk. Hepatitis B is the highest risk virus as it is present in greater concentrations in blood; it is resistant to simple detergents; and it can survive on environmental surfaces for up to 7 days. Research has shown that athletes are more likely to acquire blood borne virus infections in off-the-feld settings e. Individuals with acute viral infections may not be well enough to participate for a period of time after the initial infection and their treating doctor will advise on when they can return to sporting activities. In the event of an acute bleeding injury during an activity pupils cannot return to the feld of play until the wound has been cleaned and disinfected, bleeding has stopped completely, and the wound is covered with a secure, occlusive dressing. If the wound cannot be securely occluded then the pupil cannot return to the sporting activity. Skin Infections Skin infections that can be transmitted during high risk contact sports include fungal, bacterial and viral infections. Bacterial and fungal infections may also be transmitted by contact with equipment such as exercise mats. If an outbreak of a skin infection occurs on a team, all team members should be evaluated to help prevent further spread of infection. However transmission can be reduced by educating pupils to wash feet regularly, dry between the toes thoroughly, and wear cotton socks. The infection should be treated and infected pupils should wear protective footwear in showers and changing rooms. However, prompt treatment with topical or oral anti- viral medication can reduce the length of symptoms, viral shedding and infectivity. Children with active lesions should not share eating utensils, cups, water bottles, or mouth guards. Exclusion of Pupils with Skin Infections who are Involved in High Risk Contact / Collision Sports High risk sports that involve signifcant skin-to-skin contact with an opponent or equipment require stricter participation restrictions for infected people. For high risk contact and collision sports it is not usually appropriate to permit a player with active skin lesions to return to play with covered skin lesions. Participation with a covered lesion can be considered for lower contact sports if the area of skin can be adequately and securely covered. Players should not be allowed return to high risk sporting activities until these are met. Many of these exclusion criteria require the correct diagnosis and treatment of the skin infection. Many also specify the duration of treatment that must be completed before the pupil can return to play. Covering of active skin lesions is generally not permitted to allow return to play. For lesions that are permitted to be covered the recommended approach is to cover with a bio-occlusive dressing then pre-wrap and tape. Therefore, it is recommended that pupils do not participate in body contact / collision sports for 4 weeks after onset of illness. Due to the nature of the illness many pupils may not be ready to return to full team participation within 4 weeks. Tetanus Tetanus is a severe disease but, thanks to vaccination, is now rare in Ireland. However, spores from tetanus bacteria are ubiquitous in soil, particularly ground contaminated by animal faeces, such as sports felds used by farm animals. Therefore the potential for tetanus spores to enter into a wound or break in skin remains. Precautions for pupils undertaking sporting activity in outdoor settings where contact with soil is likely include: • Pupils should be appropriately immunised with tetanus containing vaccine (4 doses <11-14 years of age; 5 doses >14 years of age). It is not intended as a diagnostic guide or as a substitute for consulting a doctor. A child who has an infectious disease may show general symptoms of illness before development of a rash or other typical features.

During this situation buy discount penegra 50mg on-line, protein break- down becomes a source of indispensable amino acid needs for synthesis of proteins critical to maintaining essential body function (Reeds et al purchase 100 mg penegra amex. This labile protein reserve in humans is unlikely to account for more than about 1 percent of total body protein (Waterlow discount penegra 100 mg free shipping, 1969 discount penegra 100 mg amex; Young et al. Thus, the immediately accessible stores of protein (which serve as the source of indispensable amino acids and amino nitrogen) cannot be considered in the same light as the huge energy stores in the form of body fat; the labile protein reserve is similar in weight to the glycogen store. The protein lost during fasting is functional body protein and thus there is no evidence for a protein reserve that serves only as a store to meet future needs. There is a wide range of variation in daily dietary protein intake, from the protein requirement and beyond, to which the body is able to adapt over a period of days, after which no further change in body protein con- tent occurs. However, pathological conditions, such as severe disease states, can cause substantial rates of protein loss due to the increased demand for either amino acids or carbon skeletons to meet local energy demands. If these conditions go unchecked for more than a few days, there may be a serious depletion of the body’s protein mass, which might eventually become life threatening. Although the evidence from short-term changes in diet suggests that the main loss of protein is from the viscera (de Blaauw et al. Although the free amino acids dissolved in the body fluids are only a very small proportion of the body’s total mass of amino acids, they are very important for the nutritional and metabolic control of the body’s proteins. The content of free and protein-bound amino acids in rat muscle is shown in Table 10-2. It can be seen that their ranges are considerable and that their concentrations in the free pool are in no way related to their concentrations in body proteins. In the human, free phenylalanine com- prises less than 2 percent of its total body pool, and corresponds to only about 1. Free glutamate and alanine comprise a larger proportion of their respective body pools, but they could not be considered as reserves for more than a very short time. In human muscle, glutamine has an exceptionally large free pool, containing about 10 to 15 g of nitrogen. After trauma, this pool can become depleted by more than 50 percent (Labow and Souba, 2000); its loss may then make a significant contribution to the total loss of nitrogen. Although the plasma compartment is most easily sampled, the concen- tration of most amino acids is higher in tissue intracellular pools. Typically, large neutral amino acids, such as leucine and phenylalanine, are essen- tially in equilibrium with the plasma. Others, notably glutamine, glutamic acid, and glycine, are 10- to 50-fold more concentrated in the intracellular pool. Dietary variations or pathological conditions can result in substantial changes in the concentrations of the individual free amino acids in both the plasma and tissue pools (Furst, 1989; Waterlow et al. Pathways of Amino Acid Metabolism The exchange between body protein and the free amino acid pool is illustrated by the highly simplified scheme shown in Figure 10-2. Similarly, there is a second pool, consisting of the free amino acids dis- solved in body fluids. The arrows into and out of the protein pool show the continual degradation and resynthesis of these macromolecules (i. The other major pathways that involve the free amino acid pool are the supply of amino acids by the gut from the absorbed amino acids derived from dietary proteins, the de novo synthesis in cells (includ- ing those of the gut, which are a source of dispensable amino acids), and the loss of amino acids by oxidation, excretion, or conversion to other metabolites. Amino Acid Utilization for Growth Dietary protein is not only needed for maintaining protein turnover and the synthesis of physiologically important products of amino acid metabolism but is, of course, laid down as new tissue. Studies in animals show that the composition of amino acids needed for growth is very simi- lar to the composition of body protein (Dewey et al. It is important to note, however, that the amino acid composition of human milk is not the same as that of body protein (Dewey et al. Maintenance Protein Needs Even when mammals consume no protein, nitrogen continues to be lost. Provided that the energy intake is adequate, these “basal” losses are closely related to body weight and basal metabolic rate (Castaneda et al. In man, normal growth is very slow and the dietary requirement to support growth is small in relation to maintenance needs except at very young ages. It follows that maintenance needs are of particular impor- tance to humans and account for a very large majority of lifetime needs for dietary protein. It has been known for decades (Said and Hegsted, 1970) that the body’s capacity to conserve individual amino acids at low intakes varies, so the pattern of amino acids needed in the diet to match their individual catabolic rates does not correspond precisely with the composition of body protein. This implies that there is very effective recycling of indispensable amino acids released continuously from protein degradation back into protein synthesis. Under conditions where the diet is devoid of protein, the efficiency of amino acid recycling is over 90 percent for both indis- pensable and dispensable amino acids (Neale and Waterlow, 1974). While highly efficient, some amino acids are recycled at different rates than others. Physiology of Absorption, Metabolism, and Excretion Protein Digestion and Absorption After ingestion, proteins are denatured by the acid in the stomach, where they are also cleaved into smaller peptides by the enzyme pepsin, which is activated by the increase in stomach acidity that occurs on feed- ing. The proteins and peptides then pass into the small intestine, where the peptide bonds are hydrolyzed by a variety of enzymes. These bond- specific enzymes originate in the pancreas and include trypsin, chymotrypsins, elastase, and carboxypeptidases. The resultant mixture of free amino acids and small peptides is then transported into the mucosal cells by a number of carrier systems for specific amino acids and for di- and tri-peptides, each specific for a limited range of peptide substrates. After intracellular hydrolysis of the absorbed peptides, the free amino acids are then secreted into the portal blood by other specific carrier systems in the mucosal cell or are further metabolized within the cell itself. Absorbed amino acids pass into the liver, where a portion of the amino acids are taken up and used; the remainder pass through into the systemic circulation and are utilized by the peripheral tissues. Thus, a significant portion (at least 50 percent) of fecal nitrogen losses represents the fixation by the colonic and cecal bacteria of nitrogenous substances (urea, ammonia, and protein secretions) that have been secreted into the intestinal lumen. Some authors have argued that the host-colon nitrogen cycle, by which nitrogenous compounds that diffuse into the gut are converted to ammonia by the microflora and are reabsorbed, is a regulated function and serves as a mechanism of nitrogen conservation (Jackson, 1989). The theoretical basis of this proposition has been partly confirmed by the recent demon- stration of the availability to the host of indispensable amino acids synthe- sized by intestinal microbes (Metges et al. However, not all investigators have obtained results indicative of regulated nitrogen cycling (Raguso et al. Although it seems clear that the efficiency of dietary protein digestion (in the sense of removal of amino acids from the small intestinal lumen) is high, there is now good evidence to show that nutritionally significant quantities of indispensable amino acids are metabolized by the tissues of the splanchnic bed, including the mucosal cells of the intestine (Fuller and Reeds, 1998). Thus, less than 100 percent of the amino acids removed from the intestinal lumen appear in the peripheral circulation, and the quantities that are metabolized by the splanchnic bed vary among the amino acids, with intestinal threonine metabolism being particularly high (Stoll et al. Currently, there is a lack of systematic information about the relationship between dietary amino acid intake and splanchnic metabolism, although there are indications that there is a nonlinear rela- tionship between amino acid intake and appearance in the peripheral blood (van der Schoor et al. Intestinal Protein Losses Protein secretion into the intestine continues even under conditions of protein-free feeding, and fecal nitrogen losses (i. Under this dietary circumstance, the amino acids secreted into the intestine as components of proteolytic enzymes and from sloughed mucosal cells are the only sources of amino acids for the maintenance of the intestinal bacterial biomass. In those studies in which highly digestible protein-containing diets have been given to individuals previously ingesting protein-free diets, fecal nitrogen excre- tion increased by only a small amount. The following points support the view that the intestinal route of protein (amino acid) loss is of quantitative significance to maintenance protein needs. First, continued mucosal cell turnover and enzyme and mucin secretion are necessary for maintaining the integrity of the gastrointestinal tract and its normal digestive physiology. Second, animal studies show that the amino acid composition of the proteins leaving the ileum for bacterial fermenta- tion in the colon is quite different from that of body protein (Taverner et al. In particular, the secretions are relatively rich in dispensable amino acids as well as threonine and cysteine (Dekker et al. These two amino acids are of significance in meeting amino acid needs when intake is close to the requirement (Laidlaw and Kopple, 1987). Other routes of loss of intact amino acids are via the urine and through skin and hair loss. These losses are small by comparison with those described above, but nonetheless may have a significant impact on esti- mates of requirements, especially in disease states (Matthews, 1999). From a nutritional and metabolic point of view, it is important to recognize that protein synthesis is a continuing process that takes place in most cells of the body. In a steady state, when neither net growth nor protein loss is occurring, protein synthesis is balanced by an equal amount of protein degradation. Protein Degradation The mechanism of intracellular protein degradation, by which pro- tein is hydrolyzed to free amino acids, is more complex and is not as well characterized at the mechanistic level as that of synthesis (Kirschner, 1999). A wide variety of different enzymes that are capable of splitting peptide bonds are present in cells. However, the bulk of cellular proteolysis seems to be shared between two multienzyme systems: the lysosomal and proteasomal systems. The lysosome is a membrane-enclosed vesicle inside the cell that contains a variety of proteolytic enzymes and operates mostly at acid pH. Volumes of the cytoplasm are engulfed (autophagy) and are then subjected to the action of the protease enzymes at high concentra- tion. This system is thought to be relatively unselective in most cases, although it can also degrade specific intracellular proteins (Cuervo and Dice, 1998). The system is highly regulated by hormones such as insulin and glucocorticoids, and by amino acids (Inubushi et al. The first step is to join molecules of ubiquitin, a basic 76-amino acid peptide, to lysine residues in the target protein. Several enzymes are involved in this process, which selectively targets proteins for degradation by a second component, the proteasome.

Use the riddles on the handout “Learn More About Drugs” to give the students more information about each of these substances generic 100mg penegra visa. Lead a discussion about the different drugs the students learned about and answer any questions they may have buy penegra 50 mg. One circle should say “Drugs That Help the Body safe 100mg penegra,” and the other circle should say “Drugs That Hurt the Body buy discount penegra 50 mg. Have each student or group make a list of the most important things to know about the effects of drugs on the body. Students may want to create a brochure or poster identifying the effects different drugs have on the body. Divide the students into pairs and have them test each other until both students have really grasped the information about each substance. Then have each student make a large drawing showing the setting in which that drug would be used. For example, immunizations may be given at the doctor’s offce, a clinic, or the hospital. Have the students write a class play about one of the drugs studied during the mission. The play could be about how a drug was discovered, how it is used, and what impact it has had on our lives. Do students understand the difference between a drug that has a helpful effect and one that has a harmful effect? As a class, go to the Library/Media Center and look for books or Web sites about one or more of the drugs studied during the module. Discuss what they mean and how they apply to what the students learned during the module. Bring out the list the class generated during module 2, describing what the students wanted to learn about the brain. Students can take turns being the player, and the rest of the class can be the audience. If the player doesn’t know the answer, he or she has the option of asking the audience for help. Have the students write a class story about the substances they learned about during this module. Begin with the prompt, “If I was stranded on a desert island, I would like to have with me. Have students think back to what they learned about the parts of the brain in module 2 and neurotransmission in module 3. Have them make up riddles describing the parts of the brain or the process of neurotransmission. Part of the “Drug-Alert Book” series, gives a good overview of the brain, neurotransmission, the effects of drugs on the brain, and addiction. Gives a good overview of medicines and how various medicines work with the body and brain to help heal. Gives a good overview of nicotine and caffeine and how each of these drugs affects the body and brain. I come in two different forms—one from the lab and the other from willow tree bark. So when you’re in pain, don’t stay in the dark, Try me, and I guarantee that you’ll feel better fast; I’m a painkiller that really lasts. These kinds of drugs make it harder to think; They affect your brain, which can really stink! You drink me every day; When you turn on the tap, I fow down the sink every which way. So keep this information in your mental fle, Because I’m the secret to your white, healthy smile. I’m so strong that kids can’t drink me until they’re 21, And even adults should know when enough is enough and then be done. I am found in many things that are yummy to eat, Like chocolate, soda, and other treats. I’m not the one that makes people choke, But I am the biggest reason people smoke. You might want to use these riddles during the “Discussion Questions” part of the mission. I change the chemicals in your body, you see, And then pain and fever disappear for you and for me. For an immunization, the germs from the illness are changed and then injected into the body, which teaches the body’s own defense system to fght the disease. Each kind of me changes the brain; Once the brain is changed, it’s never quite the same. Marijuana is one kind to smoke, And the white powder, cocaine, is also called coke. It also affects the cerebellum, the part of the brain responsible for balance and coordination. Both cocaine and marijuana turn on the pleasure center, part of the limbic system, making the body crave the substance. I can harden your teeth and make them strong; Dentists love me because I keep kids away from the drill for so long. Fluoride hardens and repairs enamel, the covering on teeth, and prevents cavities from forming. When you have strep throat and you feel really sick, I kill all the germs—I do the trick. Pretty soon, you feel okay; Then I’ve done my job, and the bacteria have gone away. Alcohol keeps people from thinking clearly, slows down the ability to respond to danger, makes people sleepy, and can kill neurons. That’s not all that I do; I also can make it harder to write words that are clear, fresh, and new. Caffeine makes people feel more awake but less able to write or draw well due to shaky hands. I don’t mean to make people smoke forever and ever, But I guess I’m just oh so clever. Nicotine takes away people’s appetite, speeds up the heart, and changes the brain so that it needs nicotine to work normally. Brain Teaser hasn’t been able to make it to the club for a couple of days because he sprained his ankle. In fact, the whole idea is to get you kids thinking about the difference between drugs used as medicines and drugs used for other purposes. Here goes: You can use me on waffes and pancakes, I’m brown, sweet, sticky, and with me a mess you can make. During the frst three modules, we introduced the parts of the brain and the process of neurotransmission so that now, by module 4, the children have some understanding of the complexity of the central nervous system. One group of drugs, with a benefcial effect on the body, includes medicines that they have probably taken—aspirin/Tylenol, antibiotics, immunizations, and fuoride. The other category, which can have harmful effects on the body, includes alcohol, nicotine, and illegal drugs, such as marijuana and cocaine. One of the points we emphasize in the module is that all these substances are powerful. Even helpful drugs must be taken under the right conditions and given by trusted individuals—parents or health care professionals, for example. If too much medicine is given, that can be just as dangerous as taking an illegal substance. Help provide your child with more knowledge so that when the time comes, he or she will make a solid, science-based decision not to take drugs. For example, if you have a glass of wine with dinner, explain that your choice is okay because you are an adult, are drinking in moderation, and are not doing anything dangerous, such as driving after drinking. Emphasize that adults can make these choices, while children are not yet old enough. By learning about how the brain works and about drugs, however, your child is getting a foundation to make thoughtful decisions in the future. Additional Resources The books and Web sites listed below have more information about drugs. This book provides a good abuse and a section designed specifcally for overview of the brain, neurotransmission, the parents, teachers, and students. Gives a good overview of nicotine This site is designed specifcally for young and caffeine and how each of these drugs people to learn about the effects of drug abuse affect the body and brain. I can be a gas, aspirin that makes a person better is from like air, or a liquid, like water. I am a pill or liquid mouthwash, and even in the water that makes headaches and fevers supply. People who use me might not be sick person fight germs and get able to stop taking me, even if they become very, very better. People who use me might not be sick person fight germs and get able to stop taking me, even if they become very, very better. They are administered by people who care about children like parents, doctors, dentists, and other care givers. Helpful medicines include aspirin/Tylenol, antibiotics, fluoride, and immunizations. Most of these drugs are illegal for children, and some are even illegal for adults.

Professionals who can assist patients to understand and transform unhealthy behaviors into health promoting ones are essential members of the Lifestyle Medicine treatment team 100 mg penegra with amex. These professionals should have a degree in psychology or a related field or certification as a health coach order 100 mg penegra with amex; a valid state license to practice if needed cheap penegra 100mg with visa; and training in the principles of Lifestyle Medicine to ensure that all patients get the same clear consistent message from all members of their treatment team order penegra 100 mg visa. Nurse Practitioners/Physician’s Assistants/Nurses/Medical Assistants Medical office staff with direct patient contact can reinforce or detract from the Lifestyle Medicine message of the practice. These professionals need standard certifications and state licenses plus formal or in-service training on the basic principles of Lifestyle Medicine. Training would include the benefits of a plant based diet, regular exercise, and stress management techniques that these professionals can incorporate into their personal lives and share with patients. Preventive care as currently practiced focuses on screening to detect diseases that can be treated with pharmaceuticals drugs or surgery. Lifestyle issues are not always effectively addressed in the setting because of provider training and time constraints. There is a need for development of effective complementary methods to provide lifestyle health information to patients such as:  Workplace environmental and human resource interventions  School presentations or incorporation of Lifestyle principles into school curricula. It is an excellent way to assist patients to form community around solving their health care problems. Currently, the typical patient spends 15- 30 minutes with a doctor/health provider during an individual medical appointment. Patients often report that before they were finished relating their problem the provider was writing a prescription and indicating that the session is over with no explanation of the medical problem or the medications prescribed. A shared appointment can last from 90 minutes to 3 hours depending on the structure of the Lifestyle Medicine intervention. This allows patients to spend more time with their healthcare team and with other patients who have similar health issues. Patients can learn from the health care team and from each other, sharing stories and ideas and creating social bonds. Diseases such as cardiovascular disease, diabetes and Crohn’s disease that were once thought to be irreversible have all been completely reversed by comprehensive lifestyle changes. There is a wide variety of health promoting behaviors that have been successfully used in the treatment of lifestyle diseases but generally most lifestyle related diseases benefit from the same simple lifestyle behavior changes. These include, but are not limited to optimum nutrition, physical activity, stress management, tobacco cessation, and improved interpersonal relationships. Eating behaviors are formed in childhood and determined not by conscious thought but by unconscious sociocultural norms, beliefs, and taste preferences. The most current scientific evidence available supports the use of whole unprocessed or minimally processed plant foods as treatment for most of the lifestyle related illnesses in our population 28, 29, 30, 31 Regardless of medical specialty, all physicians should be educated about this scientific literature, and advising patients to make these dietary changes should be considered the standard of care. A brief nutrition survey should be repeated periodically at follow-up visits to assess progress or deterioration. Nutrition/dietary treatment prescriptions should be based on the results of nutrition assessments and evidence-based nutrition research. This can include a wide variety of activities such as providing nutrition clinics, seminars and other resources, introducing patients to new foods at food sampling events, holding cooking classes, providing personalized meal plans with shopping lists, leading supermarket and farmers market tours, visiting urban farms, starting community gardens, organizing personal chef services and/or providing packaged foods services to make healthy food choices more convenient for busy patients. Every five years the Federal government issues dietary guidelines that are intended to promote health and also satisfy food industry interests. Current Federal dietary guidelines recommend decreasing cholesterol and saturated fat intake, and increasing intake of fruits, vegetables, legumes and whole grains. Dietary cholesterol crystals injure All ages and endothelial cells and start the inflammatory process that 36 genders leads to heart disease and strokes. The health benefits of exercise apply to children and adults of all ages and social groups and to patients with chronic diseases and disabilities. Any lifestyle improvement advice given by health care professionals is valuable, but exercise advice alone without dietary changes will be ineffective for many patients. Exercise without dietary changes may maintain current weight but will not lead to significant weight loss or reversal of lifestyle diseases such as atherosclerosis. A basic assessment measures flexibility, strength, and cardiovascular endurance, other parameters may be added as needed. Most of ¨When possible try to meet the Adolescents the time should be either moderate- or vigorous-intensity guidelines. If this is 64) minutes a week of vigorous-intensity aerobic physical activity not possible, patients should be as or an equivalent combination of moderate- and vigorous- physically active as their abilities intensity aerobic physical allow. Older Adults Follow the adult guidelines, or be as physically active as Develop an activity plan with (65+) possible. All patients should be screened initially and periodically for signs of unhealthy stress responses and stress-related conditions such as depression. Lifestyle Medicine providers should be knowledgeable about basic evidence-based stress management techniques that they can share with patients. Common evidence-based stress- management techniques include: Autogenic training/Guided Imagery,47 are relaxation techniques that involves visualizations to induce a state of relaxation. Patients can use an instructor, tapes, or scripts to guide them through the process. Practiced daily for 15 minutes 3 times a day the technique has been shown to alleviate many stress- related life conditions such as chronic pain, tension headache, anxiety, and depression. Distorted thoughts/cognitive distortions underlie many forms of unhealthy behaviors and mental illnesses. Diaphragmatic Breathing 47 is a breathing technique that focuses on movement of the abdomen when breathing. This type of breathing has been shown to lower blood pressure, reduce pain, and reduce anxiety especially in children with asthma. Meditation 47 is a catch-all term for a wide variety of practices where individuals attempt to focus awareness. Countless studies have shown the benefits of meditation as treatment for stress related health conditions. Measurable physiological changes such as decreased heart rate, respiration, blood pressure and positively altered brain wave activity have been documented during meditation. Meditation has been shown to promote relaxation, improve cognitive function and relieve depression, anxiety and chronic pain. This technique involves alternately tensing and relaxing muscle groups over the legs, abdomen, chest, arms and face in a sequential pattern while focusing on the difference between the feelings of the tension and the feelings of relaxation. Other evidence-based stress reduction techniques that Lifestyle Medicine Practitioners should be aware of include relaxation response, biofeedback, emotional freedom technique, mindfulness-based stress reduction exercises and emotional freedom techniques. Clinicians should be aware of motivational techniques to encourage patients who are not ready to make quit attempts. Tobacco use cessation counseling and medications can be effective when either one is used alone but they are most effective when used together. In a Lifestyle Medicine practice the method used should be individualized to suit patient needs and preferences. Tobacco use cessation medications are contraindicated in certain groups such as pregnant women, smokeless tobacco users, light smokers, and adolescents. Tobacco use cessation counseling may be conducted in individual one-on-one sessions, groups, or on telephone quit lines. Important components of tobacco use cessation counseling are practical problem solving/skills training and social support. The nicotine replacement products are available over-the-counter in 5 forms, as gum, inhaler, lozenge, nasal spray and patch. Tobacco use cessation treatment is an important part of Lifestyle Medicine treatment and may be offered alone or as part of a comprehensive lifestyle intervention program. The areas in our brain involved in processing social stimuli and decision making are noticeably larger in those with large social networks. People with seemingly caring families and demanding jobs may be most in need of genuine social connection. Lifestyle Medicine prescriptions for developing or improving social relationships should be personalized to meet the needs of individual patients. Advice to prevent social isolation may include volunteering for a meaningful cause, involvement in spiritual/religious activities or participation in communication skills workshops such as Compassionate (nonviolent) Communication. This is especially true when the changes involve new ideas and behaviors that are different from accepted sociocultural norms. The ability to understand criticism and handle rejection and possible social isolation will determine whether the new healthy behaviors are sustained. Helping patients to develop these skills should be a consideration in a Lifestyle Medicine practice. The practice may offer or facilitate access to workshops that assist patients to improve health literacy,63, 64 develop active listening skills, resolve internal and external conflicts to produce win-win solutions,65 improve intimacy,57 and improve workplace relationship with a view to negotiating successful personal lifestyle changes in possibly resistant family and other social settings. Committee on Nutrition in Medical Education, Food and Nutrition Board, National Research Council. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. The China Study: Startling implications for diet, weight loss and long-term health. Exercise, Appetite and Weight Management: Understanding the Compensatory Responses In Eating Behaviour And How They Contribute To Variability In Exercise-Induced Weight Loss. Stress reactivity and its Association with Increased Cardiovascular Risk: A Role for the Sympathetic Nervous System? The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. Stress Management Techniques: Evidence-Based Procedures that Reduce Stress and Promote Health. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.

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