Water therapy and Tai Chi for Rheumatoid Arthritis (RA)

Water Therapy: Water therapy is a kind of CBT that has adjustable levels and can be applied with help of special mechanism. Loyd, Vargas (2004) describes the commonly used method of giving water therapy by placing the human patient in a water basin that is custom made for this purpose. Pump driven water circulation (the intensity of which can be adjusted) is applied by streams of water that come from various openings in the basin. The motor is attached to a controller that patient has access to and can control the intensity of circulation without having to exit the water basin. Water therapy is usually administered at a spa facility, physical therapy unit (that is equipped with water therapy machine) or even at home in bath tubs that are also known as ‘Jacuzzis’ (Elkayam et al., 1991)

Effectiveness of Water Therapy: Danneskiold-Samsøe et al. (1986) explain that it is well known that patients suffering from rheumatoid arthritis have a reduced muscular function. In their study, they observed the effects of exercise therapy in a heated pool for eight RA patients and after two months found increase in strength of patient. They conclude that use of water therapy as a CBT for RA patients can be an effective method to increase physical capacity of patients. The use of water therapy has been understood by some researchers in comparison to same physical activity on dry ground. According to Melton-Rogers, Hunter, Walter, Harrison (1996) exercising in the water gives the RA patients a chance to get the physical activity levels that they are comfortable for a long term. Their study was with eight RA patients by monitoring their pain, rate of perceived exertion (RPE), heart rate, oxygen intake during biking on the ground and then doing similar activity in the water. Results showed lower RPE during ground biking and mixed results for other monitored body functions as well. It was noted that both kind of activities would provide necessary activity as suggested by the American college of sports medicine, but water exercise has a higher chance of patients continuing it in the long run. 

Method to use Water Therapy: McIlwain, Bruce (2003) suggest to get into a heated pool three times a week at least and participate in water aerobics, also known as aquatics exercise two to three times a week for a pain free arthritis. Their article is quiet clear in explaining that exercise may seem like a challenge as a thought for RA patients, but when practiced in the water as part of water therapy, it can relief almost all of the pain from RA. Like any kind of treatment, it is important to know how often a CBT is used to show results.

The method explained above by McIlwain, Bruce (2003) sound similar to the kind of mechanisms found in simple Jacuzzi bath tubs. Most modern houses are constructed with these kinds of bathtubs built in and installation is not too expensive either if weighed in reference of the benefit they may provide as water therapy. In an effort to encourage RA patients to use water therapy as a CBT we would aim to schedule a consult with the patients to educate them on the benefits of water therapy and highlight the simplicity of using the method in their own homes.

            The challenge is when you approach RA patients from lower socioeconomic status (SES) as they may not have enough financial health coverage or a house facility equipped with a hot tub or Jacuzzi bath. In that case we could suggest joining a local pool like the YMCA, which allows membership at nominal cost and use the facility to exercise water exercise. 

Tai Chi: Tai Chi is a form of martial arts that originated in ancient China and is today a strong part of the health care system in China. Many people in China and other South Asian countries practice Tai Chi religiously every morning with the belief that it prevents as well as cure lot of chronic diseases (Chi, 2009). Today Tai Chi is thought to benefit hypertension, asthma, knee problems, stress and RA in China as well as in the Western world. Chi in Chinese medicine means free flowing energy and its believed that it must flow freely for good health; block chi can cause health problems (Chi, 2009). Chang, the founder of Tai Chi created specific postures (a version of martial arts) that facilitate a free flow of energy throughout the body.   

Effectiveness of Tai Chi: Peterson (2014) writes that Tai Chi like yoga and weight bearing activities has shown to improve flexibility in RA patients. Some recent studies by NIH have revealed that Tai Chi helps patients recover from chronic diseases that involve inflammation like RA (Chi, 2009). Uhlig et al. (2010) conducted a study aimed at understanding in which ways Tai Chi impacts disease activity, health and physical function in RA patients. The study used qualitative and quantitative methods with 15 patients (ages 33-74) who practiced Tai Chi twice a week for 12 weeks. Results showed that after 12 weeks there was reduction in stress, better understanding of handling RA pain and improved lower limp function. Tai Chi is a great CBT for RA patients that has shown to improve health in many ways and is a cost effective technique.

Methods to use Tai Chi: The primary technique to practice Tai Chi is to learn slow, controlled postures that are mostly named for animals or nature (Chi, 2009). Each posture is designed to help flow of energy and correct any blockage of energy flow. Tai Chi can be practiced in a group, but for its effectiveness it is crucial that it is practiced daily, and therefore, encouraged to do solo as well (Chi, 2009). It is reported that unlike other rigorous exercises, Tai Chi practice of gentle, flowing movements is comparatively less intense and more long lasting. It is usually taught by a master and has been observed to be easy to teach to the elderly with limited movement easily.

            Since Tai Chi is relatively a newer concept in some parts of the world, we can assume that some RA patients maybe not familiar with the practice. We have established that Tai Chi originates from China and popular in South Asia to promote health. It is still gaining familiarity in the Western, Middle Eastern cultures and this may be due to health care access, religious or cultural beliefs. RA patients who are not familiar with the Chinese culture, practices and use of Tai Chi as a CBT would need to educated properly about the practice. It should be noted that Tai Chi is a form of exercise that needs be learnt and practiced, so it is crucial that this population be familiarized the background of Tai Chi. If we are able to find a common ground in the practice of Tai Chi and the CBT used in other cultures, then that may bridge the barrier of being unfamiliar. It is then also important to follow up that RA patients understand the importance of regularity and every day practice to see results. 

                                                                        References

Chi, W. T. (2009). Tai Chi for Health.

Danneskiold-Samsøe, B., Lyngberg, K., Risum, T., & Telling, M. (1986). The effect of water exercise therapy given to patients with rheumatoid arthritis.Scandinavian journal of rehabilitation medicine, 19(1), 31-35.

Elkayam, O., Wigler, I., Tishler, M., Rosenblum, I., Caspi, D., Segal, R. & Yaron, M. (1991). Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. The Journal of rheumatology, 18(12), 1799-1803.

Family Composition effects life's decision: Literature Review

 ‘Family composition’ is a concept which can be simply defined, yet it can be an extensive concept depending on in what context it is understood. For some people ‘family composition’ is where an individual comes from like divorced or married parents, how many siblings and for others it may include grandparents, God parents or even extended family. This is the goal of our research study to understand how different cultures define ‘family composition’ and the importance they attach to family in an individual’s life.

Skinner (1997) highlights the concept of family system that he reports is understood and managed differently in varying cultures. The study concludes that family system can affect behavior but not control it, however, the extent of affect family system has on an individual is still yet to be understood especially in the light of the modern trends. Some researchers have even linked the family system trends in a culture to its corporate culture like the Japanese family logics that have sustained the Japanese corporate system as well (Bhappu, 2000).

The research problem for our study is to understand to what extent and how does family composition affect the experiences and decisions in an individual’s life. We will aim to understand this in terms of Intelligence Quotient (IQ) levels, education level and personal decisions like choice of spouse, job etc. Brye (1979) explains the concept of handling death of loved ones in an Amish culture and the role of family system, quality of life.

The purpose of this study is to explore how the definition of family composition differs in different cultures and parts of the world and how does it affect people. We would achieve this by collecting, analyzing data collected from current research and doing past research review to understand how family composition plays a crucial part in an individual’s life.

          Muhuri, Preston (1991) write that in Bangladesh parents are unable to keep a balance between male and female children, with the mortality rate being highest among girls who are born after a sister. Their study shows that mortality rate is lowest among boys born after or before boys. This concludes, according to Muhuri & Preston (1991) that parents are unable to overcome discrimination between sons and daughters in Bangladesh. This is highly influenced by the cultural and religious standings of the place which means it is a very strong stance, hard to change. This is relevant in this article because our study can assist in understanding the effects of these attitudes children and how they live their adult life. Our study can help bridge the gap between family influences and adult life.

Some researchers have connected family composition to intense situations like crime, joblessness and economic disasters, as they argue that a dysfunctional family hurts the structural base of an individual (Sampson, 1987). When considering who this study will be important for then we would add populations from all walks of life and from all economic standings.

                                                                References 

Healey, M. D., & Ellis, B. J. (2007). Birth order, conscientiousness, and openness to experience: Tests of the family-niche model of personality using a within-family methodology. Evolution and Human Behavior, 28(1), 55-59.

Muhuri, P. K., & Preston, S. H. (1991). Effects of family composition on mortality differentials by sex among children in Matlab, Bangladesh. The Population and Development Review, 415-434.

Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications, Inc.

Rogers, R. G. (1996). The effects of family composition, health, and social support linkages on mortality. Journal of Health and Social Behavior, 326-338.

Scarr, S., & Weinberg, R. A. (1978). The influence of" family background" on intellectual attainment. American Sociological Review, 674-692.

Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: a review and critique of category systems for classifying ways of coping. Psychological bulletin, 129(2), 216.

Sandelowski, M. (1995). Sample size in qualitative research. Research in nursing & health, 18(2), 179-183.

Lifestyle change improves CVD

Lifestyle change is directly related to improving cardio vascular health of individuals (Sodjinou et al., 2008) and this specifically valid when studying lower socioeconomic status individuals. Dietary habits have been linked to improve cardiovascular health in a lot of past research, and a lifestyle dietary change would be eating more fruits and vegetables. It may seem like a simple step but implementing may not be as easy, especially if considering some cuisines that don’t include use of fruits and vegetables. Guthrie, Lin, Reed, Stewart (2005) report that family, culture and economic conditions are major determinants in choice of eating more fruits and vegetables. The articles also highlights that Asian Americans choose more fruits, vegetables compared to others and this choice also depends upon the individuals in the household.

In the article ‘understanding economic and behavioral influences on fruit and vegetable choices’ by Guthrie, Lin, Reed, Stewart (2005) the authors highlight how the choice of fruits, vegetables consumption are driven by behavioral, economic conditions and what are the effects of these choices of daily life. They write that a survey shows 70% of Americans believe that their diets would be healthier if they added fruits and vegetables to their daily food. Despite all the numbers, Americans are still not consuming enough fruits and vegetables. The article reports that consumption of diet rich in fruits and vegetables is associated with reduced risk of cardiovascular disease, diabetes, some cancers and other chronic diseases.

Research has shown that the population from lower socioeconomic status is the one that is lowest in consumption of fruits and vegetables (Ball, Crawford, Mishra, 2006) with some findings showing that women maybe on a lower scale. Blanchette, Brug (2005) suggests that to improve the numbers for children eating fruits an vegetables, interventions with multimedia, school based education to improve their taste preferences. Five tips to would suggest to a population to support them to adhere to the lifestyle change would be:

1. To look for local farmers as then the prices of buying, consuming fruits and vegetables would be much lower.
2. Use the modern technology of internet and get great ideas to cook, serve and eat vegetables, fruits for meals and snacks.
3. Be open to trying new cuisines and try different local restaurants if dine out with friends. Today the US is do diverse and to reach out to neighbors to exchange different dishes if living in an ethnically diverse community.
4. Frequent grocery shopping trips help keep fruits and vegetables on hand.
5. Intervention techniques that aim at improving health should include fruits and vegetables consumption benefits literature.

References

Blanchette, L., & Brug, J. (2005). Determinants of fruit and vegetable consumption among 6–12‐year‐old children and effective interventions to increase consumption. Journal of human nutrition and dietetics, 18(6), 431-443.

Guthrie, J. F., Lin, B. H., Reed, J., & Stewart, H. (2005). Understanding economic and behavioral influences on fruit and vegetable choices. Amber Waves, 3(2), 36-41.

Sodjinou, R., Agueh, V., Fayomi, B., & Delisle, H. (2008). Obesity and cardio-metabolic risk factors in urban adults of Benin: relationship with socio-economic status, urbanisation, and lifestyle patterns. BMC Public Health, 8(1), 84.

Family, peer pressure impact on adolescent diet, exercise habits

Children and adolescent spend about 32 hours a week in school, which is a substantial amount of time. Peer pressure, academic struggles and daily stress can be associated with what the children experience at school. Recently another major connection established between influences of school and life of students is of nutrition, health and food (Wechsler et al, 2000). Major steps are being taken by the government, private non-profits and by parents to change the way we feed our children at school.

In my opinion, however a stronger impact on a child or adolescent’s diet and exercise is of the family. Golan et al (1998) conducted a study to compare the traditional approach of parent being the focus for change in eating health habits compared to when children are the focus of change. Their results showed that parents are the exclusive agents when aiming to control obesity among children. According to their study results the dropout rate is higher among all other methods of weight loss among adolescents, except when parents were the main source of change. Research has shown significantly the role of parents in influencing nutritional behavior of children and adolescents (Scaglioni et al 2008). Parents are the role models for children and create an environment that promotes healthy eating behavior. Scaglioni et al (2008) also highlight that a positive and healthy home environment (happy parents, strong family system and values) can also play a part in developing a positive attitude towards life, food, friends and other things in life.

Past research establishes a strong connection between media indulgence and a child, adolescent’s health in more than one way (Marshall et al 2004). There is statistical evidence of an effect of television viewing on obesity, lack of physical activity and body fatness among children. According to American Academy of Pediatrics (AAP) American children and adolescents spend on an average 4 hours a day on media and more than the time they spend on any other activity (Barkin et al, 2006). Most of television viewing, media exposure that relates to lack of physical activity is experienced not at school but at home and among family. To limit television time and promote hobbies that promote physical activity would be an effective strategy. Parental rules in limiting screen time and getting engaged in physical activity has shown results in the past and has been suggested as an effective strategy to promote good health among children, adolescents ( Carlson et al, 2010).

Since we established that parents can play a vital role in nutritional and physical health of children, another effective strategy would the education of parents on relevant topics. This strategy could be a nip in the bud for many other related factors like taking lunch from home, highlighting the importance of health as a family and understanding the nutritional needs of the children. Giving nutritional education to parents can promote parental health, support for their kids and positive eating behaviors that will last longer (Crockett et al, 1988).

References

Barkin, S., Ip, E., Richardson, I., Klinepeter, S., Finch, S., & Krcmar, M. (2006). Parental media mediation styles for children aged 2 to 11 years.Archives of pediatrics & adolescent medicine, 160(4), 395-401.

Carlson, S. A., Fulton, J. E., Lee, S. M., Foley, J. T., Heitzler, C., & Huhman, M. (2010). Influence of limit-setting and participation in physical activity on youth screen time. Pediatrics, 126(1), e89-e96.

Crockett, S. J., Mullis, R. M., & Perry, C. L. (1988). Parent nutrition education: a conceptual model. Journal of school health, 58(2), 53-57.

Golan, M., Weizman, A., Apter, A., & Fainaru, M. (1998). Parents as the exclusive agents of change in the treatment of childhood obesity. The American Journal of Clinical Nutrition, 67(6), 1130-1135.

Marshall, S. J., Biddle, S. J., Gorely, T., Cameron, N., & Murdey, I. (2004). Relationships between media use, body fatness and physical activity in children and youth: a meta-analysis. International journal of obesity, 28(10), 1238-1246.

Scaglioni, S., Salvioni, M., & Galimberti, C. (2008). Influence of parental attitudes in the development of children eating behaviour. British Journal of Nutrition, 99(S1), S22-S25.

Wechsler, H., Devereaux, R. S., Davis, M., & Collins, J. (2000). Using the school environment to promote physical activity and healthy eating. Preventive Medicine, 31(2), S121-S137.

Wound Healing

Wound Healing, Stress and Inflammation

                           By

Aysha Siddiqui

 Dr.Debra Wilson- PSYC 6747

Walden University

Wound Healing and Inflammation

Influences of Inflammation on Wound healing

            Wound healing is a series of interactions and reactions among cells and mediators unlike the simple three step process of ‘inflammation, proliferation and maturation’ (Broughton, Janis, Attinger, 2006).Many researchers however, do explain wound healing in four steps; hemostasis, inflammation, proliferation and remodeling (Diegelmann, Evans, 2004). The healing process starts immediately after a tissue injury, when platelets come into contact with the collagen after blood components spill into the injury site. This contact starts the clotting process and the growth of essential cytokines such as platelet derived growth factor (PDGF) and gorwoth factor beta (TGF-B) (Diegelmann, Evans, 2004). The activities during wound healing is directed by chemical signals that are growth factors or cytokines which have been recently understood after observing enzyme expression, matrix production being part of the process. Singer, Clark (1999) describe wound healing as a three phase process-inflammation, tissue formation and tissue remodeling.

Influences of Stress on Wound Healing

            Kiecolt-Glaser et al., (1995) study showed that stress related incidents can have clinical effects on biological processes like wound healing or recovery from surgery. Their study took two groups of 13 women each with one controlled group that cared for Alzheimer’s patients and the other not doing that but being same in age, economic status. All participants underwent a 3-5mm biopsy wound and the results showed that caregivers healing process was much longer than the other group. Another study conducted by Ebrecht et al., (2004) showed that wound healing among healthy men is influenced by stress and not by any other health related issues like smoking, alcohol or sleeping etc. The article explains that the level cortisol is affected times of stress and this has a direct connection to the wound healing process.

            Some researchers connect the stressors to the function of the immune system and the central nervous system. Godbout, Glaser (2006) highlights that physiological stress impairs wound healing by affecting the initial inflammation phase of repair, and stress induced wound healing can lead to hospitalizations.  Wound healing being affected by stressors in life is sometimes connected to how the hormones, obesity, medication, nutrition and other conditions like diabetes, blood pressure react to stress (Guo, DiPietro, 2010)..

Experiment to examine Stress Management Techniques

For our experiment we would target a specific aging population that is susceptible to wound healing and also high risk for stress. We will target the lower socioeconomic status (SES) aging population that suffers from some chronic disease already. Research shows that individuals who are facing and managing any kind of chronic illness are sufferers of stress much more than the normal population (Felton, Revenson, 1984). Added to this past literature review also reveals that aging population from lower SES is at higher health risks that include wounds, psychological pressures, chronic illnesses (House et al, 1994). House et al. (1994) explains that in lower SES population, individual’s health declines in middle age compared to other populations that may see signs of aging health in older age.

Our experiment would aim to educate this specific population about wound healing, its connection to inflammation and most importantly how stress can hinder the healing process. The goal of our project would be to equip the population with techniques, tools to handle stress better so it would improve the overall health. This way when wound healing is required by the body, stress in not an active factor in hindering the process.

  References

Broughton 2nd, G., Janis, J. E., & Attinger, C. E. (2006). The basic science of wound healing. Plastic and reconstructive surgery, 117(7 Suppl), 12S-34S.

Diegelmann, R. F., & Evans, M. C. (2004). Wound healing: an overview of acute, fibrotic and delayed healing. Front Biosci, 9(1), 283-289.

Ebrecht, M., Hextall, J., Kirtley, L. G., Taylor, A., Dyson, M., & Weinman, J. (2004). Perceived stress and cortisol levels predict speed of wound healing in healthy male adults. Psychoneuroendocrinology, 29(6), 798-809.

Felton, B. J., & Revenson, T. A. (1984). Coping with chronic illness: a study of illness controllability and the influence of coping strategies on psychological adjustment. Journal of consulting and clinical psychology, 52(3), 343.

Godbout, J. P., & Glaser, R. (2006). Stress-induced immune dysregulation: implications for wound healing, infectious disease and cancer. Journal of Neuroimmune Pharmacology, 1(4), 421-427.

Guo, S., & DiPietro, L. A. (2010). Factors affecting wound healing. Journal of dental research, 89(3), 219-229.

House, J. S., Lepkowski, J. M., Kinney, A. M., Mero, R. P., Kessler, R. C., & Herzog, A. R. (1994). The social stratification of aging and health. Journal of Health and Social Behavior, 213-234.

Kiecolt-Glaser, J. K., Marucha, P. T., Mercado, A. M., Malarkey, W. B., & Glaser, R. (1995). Slowing of wound healing by psychological stress. The Lancet, 346(8984), 1194-1196.

Singer, A. J., & Clark, R. A. (1999). Cutaneous wound healing. New England journal of medicine, 341(10), 738-746.

Aging, Immune system and Stress

Psychosocial factors can affect the immunity at any age and for the elderly it can specific consequences (McDade, Hawkley, Cacioppo, 2006) with some populations at probably a higher risk level.  Psychological issues like depression, anxiety and social pressures can affect the immunity of aging populations in specific ways. According to Herbert, Cohen (1993) lowered proliferative response of lymphocytes to mitogens and lowered natural killer cell activity is found to be common among older populations. They write that neuroendocrine mechanisms cause depression to link to immunity. An interesting point of view is given by Rowe, Kahn (1987), who write that natural aging processes have been hyped and factors like physical exercise, diet and personal habits are undermined in their importance for healthy aging. Some researchers also argue that aging and stress, both contribute to the immune system of a person (Graham, Christian, Kiecolt-Glaser, 2006) and there is an intermingled relation between aging, stress and immunity. Immune system in aging people is affected by the stress they experienced in early life, stress can exacerbate the aging process and aging can decrease immunity as well as cause stress. This seems to explain a cyclic relation between immunity, stress and aging.

The relation between immune system and psychological stress has been long established by researchers, with age and disease increasing the risks of compromised immunity (Segerstrom, Miller, 2004). Bauer, Jeckel, Luz (2009) write that aging of the immune system is directly connected to chronic stress and healthy aging is experienced by individuals who are able to keep distress managed properly. The articles describes that emotional distress causes increased levels of cortisol to dehydroepiandrosterone (DHEA) ratio. This leads to more than usual exposure to lymphoid cells to harm glucocorticoid actions and these changes are similar in the aging process as those in innate, adaptive immune responses. The study concludes that stress management can promote better quality of health in the elderly as stress can cause premature aging due to key allostatic systems involved.

            Hyer, Kramer, Sohnle (2004) suggest that specific cognitive, behavioral interventions can affect immunity and aging process. The three techniques I would suggest are sleep therapy, family support and psychotherapy. The National sleep foundation reports that as people get older their circadian rhythms of sleep alter and sometimes this can lead to issues like sleep apnea, insomnia resulting in psychological issues. Dealing with sleep issues can assist in improving immunity in aging population. Family, social support is integral for aging population as research shows that both these things increase the subjective well-being of the aging population and results in better health, immunity (Pinquart, Sörensen, 2000).

References

Bauer, M. E., Jeckel, C. M. M., & Luz, C. (2009). The role of stress factors during aging of the immune system. Annals of the New York Academy of Sciences, 1153(1), 139-152.

Herbert, T. B., & Cohen, S. (1993). Depression and immunity: a meta-analytic review. Psychological bulletin, 113(3), 472.

Hyer, L., Kramer, D., & Sohnle, S. (2004). CBT With Older People: Alterations and the Value of the Therapeutic Alliance. Psychotherapy: Theory, Research, Practice, Training, 41(3), 276.

McDade, T. W., Hawkley, L. C., & Cacioppo, J. T. (2006). Psychosocial and behavioral predictors of inflammation in middle-aged and older adults: the Chicago health, aging, and social relations study. Psychosomatic Medicine,68(3), 376-381.

National Sleep Foundation. (n. d.). Aging and sleep. Retrieved fromhttp://www.sleepfoundation.org/article/sleep-topics/aging-and-sleep

Pinquart, M., & Sörensen, S. (2000). Influences of socioeconomic status, social network, and competence on subjective well-being in later life: a meta-analysis. Psychology and aging, 15(2), 187.

Rowe, J. W., & Kahn, R. L. (1987). Human aging: usual and successful.Science, 237(4811), 143-149.

Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry.Psychological bulletin, 130(4), 601.