General Information about Femara

It is important to seek the assistance of with a doctor earlier than starting Femara therapy and to discuss any potential risks and benefits. Doctors may carry out common bone density checks to observe for any adjustments and regulate the therapy plan accordingly.

One of the benefits of utilizing Femara over different hormone therapy medication is its decreased risk of developing blood clots and endometrial cancer. This makes it a safer choice for ladies who are at a better threat for these circumstances, such as these with a household history of blood clots or who have previously had breast cancer.

Femara, additionally known by its generic name letrozole, belongs to a class of medicine called aromatase inhibitors. These medicines work by blocking the manufacturing of estrogen in the body, which is thought to promote the growth of hormone receptor-positive breast most cancers cells. By decreasing the degrees of estrogen, Femara can gradual or cease the expansion of those cancer cells, in the end resulting in the shrinkage and regression of the tumor.

Femara is usually used as a first-line treatment for postmenopausal ladies with hormone receptor-positive breast most cancers, both alone or in combination with different therapies. This treatment has additionally been shown to be effective in treating superior or metastatic breast cancer, where the most cancers has spread to other parts of the body.

Like any medication, Femara could trigger side effects in some people. The commonest unwanted effects embrace scorching flashes, joint pain, nausea, and fatigue. In some cases, it may additionally cause bone loss, which may increase the risk of fractures. However, this risk could be lowered by taking calcium and vitamin D dietary supplements.

In conclusion, Femara is an efficient aromatase inhibitor that has been proven to be beneficial in treating hormonally-responsive breast most cancers. With its ability to block estrogen production, it's a priceless tool within the battle against this disease. However, like several medication, it might cause side effects, and common monitoring by a healthcare skilled is important to ensure the protection and effectiveness of the treatment. If you or a loved one have been diagnosed with hormone receptor-positive breast cancer, talk to your doctor about whether Femara may be an acceptable option for you.

Breast most cancers is likely one of the most common forms of cancer in women, with over 2 million cases diagnosed annually worldwide. Hormonally-responsive breast cancer, also referred to as hormone receptor-positive breast cancer, accounts for about 70% of all cases. This sort of cancer is characterized by the presence of hormone receptors in the breast most cancers cells, which may be targeted and handled with particular medications. One such treatment is Femara, an aromatase inhibitor that is used to treat hormonally-responsive breast most cancers.

Femara is taken in the type of a daily oral pill. It works by inhibiting the activity of the enzyme aromatase, which is liable for converting other hormones into estrogen. By doing so, the drug successfully reduces the manufacturing of estrogen in the body, resulting in a decrease in the dimension of the tumor and stopping its progress.

This view implies that items to assess selfefficacy should be formulated at a level of specificity that corresponds with the specificity of the outcome behavior menstruation facts cheap femara uk. Specifically assessed selfefficacy beliefs were also found to predict specific outcomes best (Bandura, 1997). Hence, the concept of general selfefficacy was developed (Schwarzer & Jerusalem, 1995a; Sherer et al. Selfefficacy should preferably be measured with a psychometric scale consisting of several items. Measurement of General SelfEfficacy Examples of items to measure general selfefficacy would be "I am confident that I could deal efficiently with unexpected events," and "If I am in trouble, I can usually think of a solution" (Schwarzer & Jerusalem, 1995a). Assessing a global measure of selfefficacy can be useful in some research contexts, for example, if multiple health behaviors, multiple chronic diseases, or adjustment to traumatizing experiences are being studied. Measurement of DomainSpecific SelfEfficacy There are measures for more or less specific selfefficacy beliefs depending on the focus of research. To investigate a healthy diet, selfefficacy items can, for example, include particular foods or refer to the selfregulatory effort to resist temptations. For safer sexual behavior, different barriers are named within selfefficacy items, such as the ability to use condoms correctly or suggest condoms to a new partner. Other examples of specific selfefficacy scales are diabetes selfcare selfefficacy, breast feeding selfefficacy, or work selfefficacy. Williams and Rhodes (2014) recently reactivated a debate about the confoundedness of selfefficacy measures with outcome expectancies and motivation and suggest including "if I wanted to" at the end of each selfefficacy items to control for some of the shared variance. Measurement of PhaseSpecific SelfEfficacy As the challenge for most health behavior is not the performance of the specific behavior but the initiation and maintenance of that behavior over longer periods of time, Scholz, Sniehotta, and Schwarzer (2005) have developed phasespecific selfefficacy beliefs. Motivational self efficacy (task or preaction selfefficacy) refers to the goalsetting phase and can, for example, be assessed with the stem "I am certain. Measurement of Sources of SelfEfficacy There has not been much research on the systematic assessment of the sources of self efficacy for specific health behaviors. According to Bandura (1997), mastery experience is the best source, followed by vicarious experience (role modeling), verbal persuasion, and physiological feedback. SelfEfficacy in Health Psychology: Some Research Findings SelfEfficacy in Health Behavior Change Theories the concept of selfefficacy was originally developed by Bandura as the key construct within his social cognitive theory (Bandura, 1977, 1997). Because of the predictive power of self efficacy beliefs for various health behaviors, other health behavior change theories like the protection motivation theory, the revised health belief model, and the transtheoretical model included selfefficacy beliefs as well. The related construct of perceived behavioral control was added to the theory of reasoned action, which was then renamed the theory of planned behavior. In the meantime, specific selfefficacy beliefs were found to be highly predictive of a wide range of health behaviors. There are also several hypotheses addressing how selfefficacy beliefs interact with other resources such as social support. Luszczynska and Cieslak (2009), for example, found support for the enabling hypothesis (assuming that social support elicits selfefficacy), as selfefficacy mediated the association between social support from families and fruit and vegetable consumption in patients after a myocardial infarction. Evidence for the cultivation hypothesis (more selfefficacious individuals mobilize more support) was found among patients after prostatectomy, who received more social support to perform pelvic floor exercises if they showed more selfefficacy previously (Hohl et al. For the adaptation of survivors of an earthquake, higher levels of family support were found to compensate for lower levels of selfefficacy (compensation hypothesis; Warner, GutiérrezDoña, Angulo, & Schwarzer, 2015). However, for individuals with high selfefficacy beliefs, additional support sometimes also shows an interference effect, for example, for autonomy beliefs of older adults (interference hypothesis; Warner, Ziegelmann, et al. General SelfEfficacy A good example of the use of general selfefficacy is a study on East Germans who migrated to the West after the Berlin Wall had come down. Over a 2year period, general selfefficacy turned out to be the best single predictor of overall adjustment, as assessed by a number of outcomes such as employment status, social integration, physical health, and subjective well being (Schwarzer & Jerusalem, 1995b). A measure of general selfefficacy proved to be valuable in this study because an assessment of all corresponding domainspecific selfefficacy measures for every coping outcome would not have been possible under the circumstances of this particular study. Measures of general selfefficacy have also been found to relate to a number of mental and physical health outcomes. PhaseSpecific SelfEfficacy In an intervention to increase breast selfexamination, task selfefficacy was associated with intention, whereas maintenance selfefficacy related to planning and behavior (Luszczynska, 2004). There is also evidence that interventions to increase physical activity affect different 610 Lisa Marie Warner and Ralf Schwarzer phasespecific selfefficacy beliefs depending on whether they focus on the adoption or maintenance of physical activity (Higgins, Middleton, Winner, & Janelle, 2014). Sources of SelfEfficacy A study on the sources of selfefficacy for physical activity in older adults concluded that mastery experiences, vicarious experiences, and subjective perceptions of health were associated with selfefficacy and physical activity over time (Warner, Schüz, Knittle, Ziegelmann, & Wurm, 2011). A longitudinal study with validated scales showed that mastery experience, selfpersuasion, and negative affective states were the most prominent predictors of self efficacy for physical activity in communitydwelling older adults (Warner et al. From a theoretical perspective, selfefficacy is built upon four sources: mastery experiences, vicarious experiences, verbal persuasion, and somatic and affective states (Bandura, 1997). Bandura states that mastery experiences are "the most effective source of efficacy information because they provide the most authentic evidence of whether one can master whatever it takes to succeed" (1997, p. However, metaanalyses have come to the conclusion that graded mastery could also lower selfefficacy. To make the most of newly gained mastery experiences, it is also essential to target a positive attributional style. Interventions can prepare for temporal setbacks and lapses to help individuals avoid what Marlatt and Gordon (1985) called the abstinence violation effect. This effect describes that people tend to see lapses as proof for incapability, which makes them drop all effort so they experience a full relapse. When people learn to attribute lapses to external causes, such as the end of a stressful day or highly tempting situations, selfefficacy can be maintained and trained for future risk situations. Although not always named among the sources of selfefficacy, Bandura also identifies mental imagery as another possible origin of selfefficacy beliefs (Bandura, 1977) and proves its use to treat phobias. Health psychological research shows that imagining the outcomes of a behavior (approach imagery) as well as the steps that need to be fulfilled to attain a goal (process imagery) can also be effective to increase physical activity among sedentary adults (Chan & Cameron, 2012).

People at high risk for poor outcomes following marital separation appear to employ coping strategies that are associated with a high degree of physiological activation women's health center yorba linda purchase genuine femara line, and this study, focused on blood pressure reactivity, provides an example of the ways in which emotion regulation strategies around attachment themes can provide insights into processes that confer risk for poor distal health outcomes. The results suggest that allowing people who are at risk for rumination to focus on actively structuring their time (rather than "digging more deeply" into the emotions associated with their separation) reduces their psychological distress following marital separation. Together, the findings related to attachment anxiety and rumination suggest potential psychological mechanisms linking marital separation to poor health outcomes. People who have a hard time distancing themselves from their psychological experiences show excessive cardiovascular responding, which, as noted above, is associated with the development of cardiovascular disease. Conceptually, this work fits well with the larger literature on selfdistanced reflection and evidence indicating that people who recount their experiences in a blowbyblow manner rather than reconstrue their experiences to find meaning are at heightened risk for mood disorders (see Kross & Ayduk, 2011). The intervention was based on a prior intervention designed to increase forgiveness for previous wrongs in a romantic relationship in college women, which resulted in higher levels of forgiveness and wellbeing for participants. Participants in both the secular and religious intervention conditions showed improvements in forgiveness of their expartner compared Relationship Dissolution and Health 543 with control, though only the secular condition evidenced decreased levels of depression. This program of research and evidence from a laboratory experiment that less forgiveness results in higher skin conductance, heart rate, and blood pressure compared with baseline (van Oyen Witvliet, Ludwig, & Vander Lann, 2001) suggests that interventions designed to target forgiveness following divorce and romantic breakups may yield benefits in health outcomes. Beyond selfdistanced reflection and forgiveness, other variables and processes may serve as potential explanatory pathways leading to healthrelevant biological changes. In a prospective study of breakups following nonmarital dissolution (Mason, Law, Bryan, Portley, & Sbarra, 2012), improvements in selfconcept clarity (knowing who you are as a person after a separation) were associated with increases in future psychological wellbeing. There was no evidence in this study that people begin to feel better, who then report a greater sense of who they are after their breakup; instead, the direction of the effect seems to operate from selfconcept clarity to improved psychological wellbeing. In a recent experimental study, Larson and Sbarra (2015) found that people who simply reflected on their separation experience multiple times over nine weeks increased their sense of selfconcept clarity, which, in turn, explained decreases in loneliness and breakuprelated emotional distress over the entire study period. Selfconcept clarity was a key variable in early accounts of the psychological response to divorce (Weiss, 1975), yet no studies to date have examined this variable with respect to biomarkers of interest. When relationships end, however, people are broadly vulnerable to morbidity and mortality from all causes, potentially due to changes in cardiovascular and immune responding. Alterations in these socalled biological intermediaries appear to be the result of changes in health behaviors, including sleep, medical adherence, selfcare, healthy eating, and exercise. There are several potential psychological mechanisms that may link the end of an intimate relationship to distal health outcomes. Examples provided in this entry include experiential overinvolvement, rumination, forgiveness, and selfconcept clarity. Because of the health risks conferred by romantic separations, it seems essential to target those most at greatest risk for poor outcomes. Future interventions after romantic separation and divorce should focus on affecting the health behaviors and psychological processes proposed to mediate the link between romantic separation and health outcomes, with the goal of reducing the health burden associated with separation. In short, romantic separation and divorce are common stressful events, and these experiences are associated with negative, healthrelevant consequences for a subset of people. Sbarra, PhD, is an associate professor of psychology at the University of Arizona. His research focuses on social relationships and health, as well as how people recover from difficult social transitions. Note 1 Although there are obvious differences between the end of marriage and a nonmarital breakup, in this entry, we consider literatures relevant to both. Association of marital status with vascular disease in different arterial territories: A population based study of over 3. Adjustment disorders of sleep: the sleep effects of a major stressful event and its resolution. Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status a metaanalysis of prospective evidence. Early life conditions, partnership histories, and mortality risk for Swedish men and women born 1915­1929. Psychological distress following marital separation interacts with a polymorphism in the serotonin transporter gene to predict cardiac vagal control in the laboratory. Adherence to cancer prevention guidelines and cancer incidence, cancer mortality, and total mortality: A prospective cohort study. Sleep complaints predict increases in resting blood pressure following marital separation. Participating in research on romantic breakups promotes emotional recovery via changes in selfconcept clarity. Attachment anxiety, verbal immediacy, and blood pressure: Results from a laboratoryanalogue study following marital separation. Facing a breakup: Electromyographic responses moderate selfconcept recovery following a romantic separation. Chronic psychological stress and the regulation of proinflammatory cytokines: A glucocorticoidresistance model. Heart rate variability moderates the association between attachment avoidance and selfconcept reorganization following marital separation. Marital dissolution and blood pressure reactivity: Evidence for the specificity of emotional intrusionhyperarousal and taskrated emotional difficulty. Psychological stress and the human immune system: A metaanalytic study of 30 years of inquiry. The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health.

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Psychologists can provide support and psychosocial interventions to assist with anticipatory grief and adjustment reactions menopause night sweats 2.5 mg femara buy amex, mental disorders, existential and spiritual issues, advance care planning, life review, and unresolved issues that are likely to surface as meaningful concerns (Haley, Larson, KaslGodley, Neimeyer, & Kwilosz, 2003). Models for Palliative Care Delivery and Their Growth in the United States In the United States much of the growth in specialty palliative care has been in the inpatient setting. This has been fueled by data showing cost avoidance as well as nonrandomized trials that suggest improved patient satisfaction and outcomes (Cassel, Kerr, Pantilat, & Smith, 2010; Morrison et al. The number of hospitals with the Wiley Encyclopedia of Health Psychology: Volume 4: Special Issues in Health Psychology, First Edition. Arnold palliative care teams increased from 658 to 1,744 between 2000 and 2013 (a growth of 165%) (Dumanovsky et al. There is however substantial variability in the availability of palliative care throughout the United States. For example, the presence of palliative care team is significantly influenced by geography, hospital size, hospital type (academic medical centers, faithbased institutions), and tax status (for profit versus not for profit) (Dumanovsky et al. Hospitalbased palliative care consultation is provided by an interprofessional team that can include physicians (including generalists and specialists, as well as psychiatrists), advanced practitioners (nurse practitioners and physician assistants) and nurses, social workers, psychologists, chaplains, pharmacists, and volunteers. A study exploring staffing of palliative care programs registered with the National Palliative Care Registry found only a quarter of the programs had a fully funded team with chaplains and social workers being the most common member who was voluntary or absent. A fully staffed palliative program provides better hospital penetration (percentage of patients who receive a palliative care consultation) and is better able to meet the needs of seriously ill patients with more timely consultations (Spetz et al. The goals of the palliative care team are to provide expert pain and symptom management, education and communication about achievable goals for care, support for decisions matched to patient and family goals, psychosocial support, and coordination of care. While the dominant model for specialty palliative care services is a consultant model, many programs also have a palliative care unit. In the National Palliative Care Registry, 5% of programs had dedicated palliative care units, typically found in larger and more mature programs (Spetz et al. Palliative care units usually serve patients who have difficultto control symptoms; medical needs that cannot be optimally managed in another setting; distressed families in need of a higher level of support; need for transfer out of a critical care setting; patients who are imminently dying. A highvolume palliative care unit may reduce inhospital care costs by matching treatments provided to patient and familydetermined goals for medical care. In one study, a dedicated palliative care unit reduced daily hospital costs by 74% compared with usual care patients (Smith et al. The nature of the palliative care intervention across randomized trials has been difficult to compare; however nonrandomized trials continue to show benefit from various ambulatory palliative care services (M. Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower healthcare utilization along with statistically significant improvement in quality of life (Kavalieratos et al. Ambulatory palliative care programs focus on delivering care aimed at better quality, improved access, and lower costs. Unlike inpatient consultation teams, ambulatory programs tend to have a wide range of structures. They can be consultative clinics in which specialty palliative care teams take referrals from other providers either as standalone clinic that is able to take referrals from different specialties or embedded programs within a specialty service. While the benefits of early palliative care consultations in clinics are being increasingly recognized (see below), the growth of outpatient palliative care programs has been less robust. There is strong evidence supporting outpatient palliative care programs providing early palliative care. Notable studies include outpatient consultations for patients with advanced cancer that showed improvement in fatigue, pain, depression, anxiety, and sleep after at least one initial visit (Yennurajalingam et al. Also, a widely publicized study from Temel and colleagues showed improved quality of life and depression as well as 2. Other models that have been explored for delivering palliative care are in nursing homes and in homebased primary care programs and collaborative care models in the emergency department. In nursing homes, specialty palliative care can be delivered by hospice organizations, external palliative care consultation team, or an internal palliative care team. The consultative team still comprises a physician accompanied by either a nurse or an advance practice provider. Formal palliative care services in the nursing home are rare because regulatory, payment, and staffing barriers prevent implementation (Meier, Lim, & Carlson, 2010). Palliative care teams in the nursing home can provide valuable education to nursing home staff on recognition of adverse prognostic signs among the frail elderly and incorporating palliative care skills into their care. While both improve quality of life, palliative care is available to patients who continue to benefit from lifeprolonging treatments. Access to palliative care is not dependent on prognosis, and there are no federal or commercial insurance benefits specific to palliative care with no formal eligibility criteria. Patients are eligible to receive hospice care reimbursed under the Medicare hospice benefit if they meet the following criteria: (a) the individual has a life expectancy of 6 months or less if the disease follows its expected course, as certified by two physicians, and (b) the individual forgoes Medicare reimbursement for ongoing therapy or curative medical treatment related to the terminal diagnosis. While there are some general guidelines for certifying the presence of a terminal illness that are applicable to all diseases, there are also specific diseaserelated guidelines. While these guidelines are helpful, they are based on clinical opinion rather than data (McCluskey & Houseman, 2004). Since the first program was established in the United States in 1982, it has grown rapidly. They vary in size; some hospices serve only 50 patients per year to large national corporate chains that care for thousands of patients each day. They also differ in their forprofit status with only about 28% holding notforprofit tax status.