Iris Publishers- Open access Journal of Otolaryngology and Rhinology | Anxiety and Smoking Behavior of Teenager in Papua, Indonesia

 

Authored by Agussalim*

Abstract

Introduction: The National Commission on child protection reported receiving an average of 200 case reports of children experiencing anxiety on a monthly basis, throughout in 2015, increasing 98% from the previous year. The report of the National Commission on child protection also indicates an increase in anxiety disorders in children in Indonesia. Papua is the province with the youngest percentage of the highest smoking in Indonesia, 3.2% of children aged 5-9 years in Papua are already smoking.

Method: Using a cross-sectional approach, meaning that all research data is taken at the same time, or each research variable data is collected only once time.

Result: Research shows from 27 students who are not anxious and behave very often there are 18 students, from 2 students who are anxious lightly and behave very often there is 1 person, from 1 student who is anxious and behave often smoke. There were 1 people, and from 1 person who was anxious and behaving smoking sometimes there were 1 people. From the data shows that P value=0.01 (P<0.05), that there is strong connection between the level of anxiety with smoking behavior in young men at Muhammadiyah Jayapura High School.

Suggestion: It is hoped that the teenagers who are active to further increase their knowledge and insights on the impact of smoking by following counseling-health counseling or accessing information in print or electronic media about the dangers of Smoking.

Keywords: Anxiety level, Smoking behavior, Teenagers, Papua, Teenager, Danger

Introduction

Adolescence begins when a child reaches a ripe age. In its development it will be faster in the early days compared to the expiration. This very short adolescence is characterized as an important period, transitional period, change period, troubled age, time seeking identity, age that raises fear, unrealistic time, and adult time limit [1]. Research on anxiety on teenagers has been conducted in some high schools. In North America, research conducted on 100 participants showed that the anxious prevalence of students was 38% (Shannone, 2015). The same research conducted by (Firth, 2015) in one of the UK schools involving 165 participants showed the anxious prevalence of students was 31.2%. Meanwhile, three studies conducted in Asia showed the results that in Pakistan, with 161 participants, the prevalence of anxious students was 30.84% (Shah, Hasan, Malik, & Sreeramareddy, 2016).

In Malaysia, with 396 participants, the student’s anxious prevalence is 41.9% (Sherina, 2015) and in Saudi Arabia against 494 participants, it is known that the student’s anxious prevalence is 57% where 21.5% is a mild anxious, 15.8% anxious and 19.6% were anxious. The research of Abdulghani (2015) demonstrates the anxiety impact especially perceived by first-year learners, and the final level. Anxiety in students can lead to decreased academic performance, decreased learning concentration, and memory decline. (Carolin, 2010). In the year 2016 National Commission on Child Protection, reported receiving an average of 200 reports of children’s cases experiencing anxiety on a monthly basis, throughout the year 2015, increasing 98% from the previous year. The report of the National Commission on Child Protection also indicates an increase in anxiety disorders in children in Indonesia. Friday, (20/03/2015), chairman of the child Protection company by Arist Merdeka Sirait revealed that it has been recorded as many as five children under 18 years trying to conduct a suicide experiment due to anxiety. Two of them have died.

Gusniati Research (Desmita, 2015:290) on students at one of the top schools in Jakarta found an anxiety phenomenon experienced by students at school. About 40.74% of learners feel overwhelmed by having to defend their school rankings, 62.96% of learners feel anxious to face a semester exam, 82.72% of learners feel afraid to get bad replay value, 80,25% are confused Completing too many homework, and 50.62% of learners feel exhausted following the extra time of study in school. In line with the expression Nugroho (2015) Children of non-regular programs tend to experience academic anxiety because it gets a burden of study that does not fit the needs. In fact, teenagers can talk about their problems and develop problem-solving skills, but because of the emotional up play and the impossibility of teenagers in making important decisions, making youth need help and support Special of adults [2]. Overcoming anxiety will be easier to do with the help of family and friends. The absence of family and friends to share a sense can cause or worsen the anxiety itself. So, they chose to overcome anxiety when there was a problem with smoking, because by smoking they believed it could relieve anxiety on him (Siswanto, 2009).

Continuous smoking can bring bad impact to the health of the body such as decreased nervous system, blood flow and appetite, increased blood pressure, heart rate, stomach acid, reduced sense of taster and smell, feeling dizzy, nausea as well as caused many dangerous diseases (Syair Abdul, 2009). According to WHO data (2014) is mentioning 1 in 10 deaths in adults is due to smoking, this cigarette kills nearly five million people annually [2-5]. If the habit of smoking continues then it is certain 3 that 10 million people will die of cigarettes. In 2014 there were 5.4 million deaths due to smoking or an average of one death every 6 seconds. Smoking is a very dangerous thing towards decreasing health productivity. Smoking can be the cause of almost 90% lung cancer, 75% chronic obstructive pulmonary disease (COPD), and 25% of the causes of heart attack.

Global Youth Tobacco Survey (GYTS) in 2014, Indonesia obtained, 18.3 percent of our students have a habit of smoking, and the details are 33.9 percent males and 2.5 percent of women. The average smoker Data of Indonesian people (15 years old and above) is about 30 percent, which means that with increasing age, the percentage of the smoker continues to increase. That is, if we can suppress the habit of smoking in young people/students, then we can also expect the number of smokers in adults can be controlled better. Indonesia is one of the countries with the largest smoker of smokers in the Duni. According to the World Health Organization (WHO) data, in 2014 the percentage of male smokers, 67%, was far greater than that of a female smoker, 2.7%. Among the smokers there were 56.7% of men and 1.8% of women smoked every day [5-9].

Papua is the province with the youngest percentage of the highest smoking in Indonesia, 3.2% of children aged 5-9 years in Papua are already smoking. For teenagers’ groups (15-19 years) are smoking daily in Jayapura city as much as 42.9% smoke cigarettes within 5 minutes. A survey of several schools in Jayapura City, each student began to smoke with a percentage of 40% as an active smoker consisting of 35% of the son and 5% of the daughter [10,11]. Agency for Health Research and Development, Wednesday (29/4/2015). The habit of smoking in students is due to unfamiliarity information, influence of advertising and influence of friends. Obtained by the Indonesian heart foundation’s poll is as much as 77% of smoking students due to the influence of friends (Imam Satria, 2009). Various facts reveal that the more adolescents smoke then the more likely his friends are smokers as well and so vice versa. From that fact there are two possibilities that occur, the first teenagers were affected by his friends or even the teenage friends were influenced by the teenage self that they eventually all became smokers [12]. Among the youth of smokers there are 87% have one or more companions that smokers as well as non-smokers Youth (Mu’tadin, 2006).

Based on the results of the interview conducted by the researchers on 27 August 2016 against 7-8 male teenagers in high school Muhammadiyah most of them are smoking because of the anxiety experienced in facing problems or pressure, than Choosing to tell a story to her parents, and a little bit of her choosing to tell her peers to get a solution from her problem, some are resigned and choose to play to forget her problem and not to smoke [13-16]. That is because the youth still lack knowledge in resolving the problem, so that the youth feel that he has no more ability. If it gets pressure or problems, they choose to smoke instead of finding a way out of the problem that is in its face.

Statement of the Problem

Based on above background, researcher formulated this research problem: “Is there a relationship between anxiety with smoking behavior of male teenagers in Muhammadiyah High School Jayapura, Papua.

Research Method

This research is a non-experimental study, research to know the relationship between variables. Al-Ummah, 2009. This research is to find out the relationship between variable levels of anxiety to the male teenage adolescent behavior at Muhammadiyah Jayapura High School. The sampling techniques in this study used purposive sampling based on a specific consideration made by researchers, based on the characteristics or properties of a previously known population.

Result

Univariate analysis

Descriptive analysis (Univariate Analysis) is intended to describe the frequency distribution of respondents responses. Based on the observation results had to give a general idea of the relationship of anxiety level with the male teenage behavior of young men in Muhammadiyah Jayapura High school 2017.

Respondent characteristic

Age: The Data in Table 1 shows that there are young men with 16 years of age numbering 11 people (35.5), 17 years old numbering 19 (61.3), 18 years old amounted to 1 person (3.2).

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Iris Publishers- Open access Journal of Online Journal of Dentistry & Oral Health | Changes in Breathing Mode, Sensory Profile and Malocclusions in Infant Patients

 

Authored by Luciana BC Fontes*

Abstract

Objective: To verify the frequency of respiratory mode changes among children assisted at a dental school, as well as the impact of this condition on the oral processing of the individual in question, comparing data recorded in medical records and those obtained in clinical and functional examination.

Method: Cross-sectional study with descriptive and inferential treatment of data, developed with children undergoing dental treatment at the Federal University of Pernambuco, Recife, northeast of Brazil and their mothers, during the first semester of 2019. These are in the age group of six to nine years. and in the mixed dentition phase, according to the defined inclusion and exclusion criteria. The project was approved by the UFPE Ethics Committee. For the statistical analysis a margin of error of 5% and the Fisher’s exact teste were adopted. Medical records and clinical and functional evaluations were considered regarding breathing mode, sensory profile and malocclusions.

Results: For a universe of 208 medical records, 33 (15.9%) had the record of respiratory alterations, with allergic rhinitis and asthma being the registered conditions. Among the children with respiratory alterations, 21.2% had mouth breathing, 18.2% had sleep alterations and 36.4% had malocclusions, with no reports of changes in sensory processing. After clinical examination and functional evaluation for the 33 children with respiratory disorders, 48.5% had sleep disorders, 97.0% had some sensory processing disorder and 81.8% had malocclusions, with significant differences between the records and the data obtained after the evaluations. The most frequent malocclusions were Angle Class I, open bite and unilateral crossbite.

Conclusion: There was a small record of respiratory changes in the records of children assisted by dentistry; however, most of these had malocclusions and disorders in sensory processing with implications for oral sensitivity.

Keywords: Malocclusion; Mouth breathing; Children; Sensation

Introduction

Respiratory problems have been a major challenge to global public health due to its high incidence and opportunity to impact the quality of life of affected individuals. Rising Earth surface temperatures, which often increase air pollution, bring the possibility of reduced lung function and the aggravation of breathing disorders. In addition, climate change leads to increased production of airborne allergens with increased asthmatic episodes, particularly among children and adolescents [1,2]. Regarding the influence of breathing on craniofacial morphology, there are several publications in the literature that have highlighted a relationship between nasal breathing mode and the normal pattern of craniofacial growth and development of teeth and occlusion. The researchers pointed out that, in the opposite condition, probable impairments would also occur in the body posture and in the sensory and cognitive performance of patients with mouth or oral breathing [3-5].

Children chronically breathing through the mouth may develop speech disorders, inadequate body posture, changes in the respiratory system, deformities of the face, and poor positioning of the teeth, leading to structural changes in the face, including lips, tongue, palate, and jaw, which will adapt to new breathing pattern. With this there is a buccolingual imbalance and consequently in the facial muscles, generating an important functional deficiency [6]. Despite evidence in the literature about the possible association between breathing mode and malocclusions, there is no further information on the frequency of respiratory problems among children attending dental school clinics, as well as the impact this condition in the oral processing of the individual concerned. The objective of the present study covers this investigation, highlighting whether there is a relationship between what is reported during the anamnesis, by those responsible, and what is found functionally.

Material and Methods

Cross-sectional study with descriptive and inferential data analysis. The study area included the Pediatric Outpatient Clinic of the University Hospital, Federal University of Pernambuco (UFPE) in Recife, the dental school-clinic of the same Higher Education Institution, the universe comprised all children assisted at the dental school clinic, in the first semester of 2019. As inclusion criteria, the sample included children from six to nine years old, with the history or record of some type of respiratory mode alteration in the anamnesis and in the mixed dentition phase, whose records included evaluations of Speech Therapy, Dentistry and Occupational Therapy. There was the exclusion of children, under speech therapy, otorhinolaryngology therapy or with the use of functional orthodontic or orthopedic appliances of the jaws. Also, those that presented some organic or neurological condition that made the communication or the functional assessment tests of the respiratory mode unfeasible.

The following study variables were age, gender, maternal level of education, presence and type of respiratory disorder, sleep problems, diagnosis of oral breathing, sensory profile, presence and classification of malocclusion. The assessment of the breathing mode was performed by otorhinolaryngology and speech pathology professionals, adopting the Protocol of Identification of Signs and Symptoms of Oral Breathing (PISSRO), according to the supplementary material, prepared by the Pathophysiology Research Group of the Stomatognathic System - GPPSE / UFPE, with information on breathing mode (with related signs and symptoms and nosologically diagnosis).

In the protocol cited above, the percentage distribution for functional diagnosis adds up to a total of responses and observations: less than 40% - no changes in breathing mode; 41% to 60%-mild oral breathing mode; from 61% to 80%-moderate breathing; above 80%-severe oral breathing. For the analysis of sensory processing, performed by an occupational therapist, the Sensory Profile Test 2 was used. This instrument captures information regarding sensory processing (auditory, visual, vestibular, tactile, multisensory and oral sensory), sensory modulation (tolerance and tone, related to body position and movement, movement modulation affecting alert level, sensory modulation affecting emotional responses, modulation of visual stimulus affecting emotional response and activity level) and emotional and behavioral responses (behavioral and emotional responses, behavioral results of sensory processing, items indicating response thresholds). The data from this analysis included the participation of mothers in the responses.

The record of the presence and types of sleep and respiratory alterations, as well as the presence and type of malocclusion existed from the data in each patient’s chart, establishing a new intraoral physical examination of these patients for occlusal evaluation [7]. This research respected the universal principles of bioethics and human rights. It was previously approved by the UFPE Ethics Committee. For data analysis, the Statistical Package for Social Sciences Software (SPSS - version 18) and Excel 2010 were used. The results are presented in table form, with their respective absolute and relative frequencies. To verify the existence of an association between oral breathing and the presence of malocclusion, Fisher’s Exact Test was adopted. The 95% confidence interval was adopted and only p values <0.05 were considered statistically significant.

Results

There was a survey of 208 medical records referring to child patients from six to nine years old, in attendance in the first half of 2019, for the dental school clinic in question. These included respiratory changes for 33 children, according to the inclusion and exclusion criteria; 17 were male (51.5%) and had a mean age of 8 (± 1.39) years. The average age of the mothers was 34 (± 8.92) years and complete high school education (75.8%).

Respiratory abnormalities were allergic in 14 children (42.4% with allergic rhinitis) and asthma in 12 (36.4%). Among the 33 patients in whom the type of respiratory disorder was discriminated, two (6.1% reported asthma and allergy). For seven children (21.2%) there was no specific cause. Regarding the classification of the child’s breathing mode as oral breathing, seven were in this perspective (21.2%). Six children had sleep problems (18.2%) and 12 (36.4%) had malocclusions. There was no record of sensory processing disorder.

The distribution of malocclusions was as follows, considering the Angle classification: five Class I, three Class II division 1 and one Class III. For the remaining four the type was not specified. Considering the registration of the other malocclusions: from the unilateral posterior crossbite records, two for the anterior open bite and two for the anterior crossbite. There was a record for bilateral posterior crossbite. Five children did not find the classification of malocclusion. Comparing the data obtained from the medical records with the respiratory mode assessments and the intraoral physical examinations of the patients, there were statistically significant differences p<0.05 in relation to the patients with oral breathing (all patients registered with respiratory alterations had this type of mode, either in the functional evaluation or in the evaluation made by the otolaryngologist).

Concerning the presence of malocclusions; these were found in 27 (81.8%) of the children assisted at the dental school in question after the intraoral physical examination, especially for Class I, Class II division 1, Class II, division II malocclusions and Class III. Also, for other types of malocclusions such as anterior open bite and unilateral posterior crossbite (Table 1). Although not included in the table, eight (24.4%) of the evaluated children had primary crowding in the region of the lower permanent incisors. There was a significant difference between medical records and data from intraoral physical examination (p <0.05). Among the children evaluated, 16 (48.5%) had sleep problems (Table 1).

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Iris Publishers- Open access Journal of Online Journal of Dentistry & Oral Health | Oral Lichen Planus-A Challenging Case

 

Authored by Iquebal Hasan*

Introduction

Lichen Planus has been classified as both a cell-mediated immune response as well as an autoimmune condition. A target antigen in the reaction has not been identified. The mechanism of action and exact classification of the condition is not fully understood. Histologically, evidence of T-cell destruction of basal cells is observed. Tumor Necrosis Factor-Alpha (TNF-a) is thought to have major involvement in this reaction. Lichenoid reactions resemble Lichen Planus both clinically and histologically but differs due to evidence of local irritant or use of certain systemic medications. Local factors could be dental materials which could include but not be limited to gold crown, PFM crown, amalgam restorations and oral hygiene products [1]. Management of oral lichen planus and lichenoid reactions poses a challenge due to lack of full understanding of the etiology. Additionally, the multifactorial probable causes of these reactions contribute to the complexity of management [2]. Oftentimes, management of symptomatic lesions and trials of varying treatment options is necessary to determine effective modes of therapy for an individual patient.

Aim

The aim of this case report is to support the use of direct Kenalog injections in diabetic patients for successful resolution of Oral Lichen Planus if topical steroids do not work. In diabetic patients’ systemic steroid is not an option because of the risk of spike in blood sugar level. Current accepted and researched modes of treatment include: Methotrexate 15mg, Sulfasalazine, Clobetasol Propionate in aqueous solution and gel form, 1% Pimecrolimun Cream, Hyaluronic Acid 0.2% Gel, Oral Alitretinoin 30mg, Levamisole Monotherapy 50mg, Topical Tacrolimus, Dexamethasone mouth wash, Photodynamic Therapy [3-13].

Case Report

An 82-year-old Caucasian female presented to East Carolina School of Dental Medicine in 2013 to establish comprehensive dental care. Patient reported history of lichen planus which was initially diagnosed approximately 40 years ago both clinically and through biopsy. Patient reported constant pain with lichen planus which worsened with certain foods; therefore, she was on a restricted diet. Patient’s previous treatments included: Dexamethasone rinse, Lidex, alcohol-free Chlorhexidine, Clobetasol Gel, Kenalog Cream, Or a base, Imuran, Folic Acid, and systemic Prednisone. None of these treatments gave her substantial relief from pain except Prednisone. She stated that she had to stop taking Prednisone because it significantly raised her blood sugar level. She also informed that she has not been able to eat several things all these years and it has adversely impacted her quality of life.

After becoming a patient at East Carolina University School of Dental Medicine, she was initially treated with topical triamcinolone, which was ineffective. Following the ineffective treatment, the patient was recommended to consult with an Oral Medicine specialist at East Carolina University by her hygienist. During this evaluation, ulcerations surrounded by areas of erythema and reticular pattern were noted bilaterally in buccal mucosa, which aligned with existing crowns. Clinical presentation was characteristic of a lichenoid reaction. Patients medical history included Arthritis, Paget’s Disease, Asthma, Hypertension, Diabetes Mellitus, and Heart disease. Two Recast infusions had been administered for Paget’s disease, first dose was administered in 2007 and second infusion was administered March 2017. Medications she was taking are Vitamin D supplement, CoQ10, Folic Acid, 81mg Aspirin, Crestor, Levalbuterol Inhaler, Bystolic. Patient was allergic to Codeine, Demerol, Morphine. She denied any other allergy.

Treatment

After initial evaluation of the patient the Oral Medicine Specialist at ECU School of Dental Medicine decided on the line of treatment. Total of 4mg of Kenalog was injected directly into the affected areas, 2mg on each side and it was coupled with Clobetasol gel for home use. Patient was recommended to monitor her blood sugar every morning and evening till the follow up appointment. At the 2-week follow-up appointment, patient reported she experienced the maximum amount of relief she had in 40 years. Patient also informed that Kenalog did not adversely impact her blood sugar level. Patient was given same dose of Kenalog injection again and told to continue use of Clobetasol gel. In the next follow up in two weeks, full resolution of lesions and symptoms were noted. Patient reported she was able to eat foods without restrictions. She was told to stop use of Clobetasol. Patient was informed that she may have flare up of the lesion again. The next flare up was in four months but was less severe and it resolved with Clobetasol gel only (Figures 1&2).

Conclusion

Occasionally lichen planus can be a treatment challenge. In some cases, patients do not respond to topical steroids and other conventional treatments. The use of systemic steroid in diabetic patients can have detrimental effects on blood glucose levels. In this case we saw that localized low dose Kenalog injections coupled with oral topical steroids can effectively treat lichen planus without effecting blood glucose levels. Further research needs to be conducted to establish it an accepted protocol in diabetic patients with persistent of oral lichen planus.

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Iris Publishers- Open access Journal of Online Journal of Cardiology Research & Reports | What are the Tensional Goals in the Frail Elderly?!

 

Authored by Rita Nascimento*

Review

In the present study we performed a literature review, aiming to understand the practical applicability of this new guidelines in the older people, and especially in frail elderly. We searched on the online database “Pubmed” the MESH terms “Hypertension” and “Frail Elderly” and we selected 32 out of 76 papers published in the last 10 years; from this 32 we selected the ones that approached the treatment targets for blood pressure. This research was complemented with the inclusion of other international guidelines and papers that were found relevant. From the papers selected to perform this review, we found guidelines, reviews and observational studies, some with conflicting results and others that are unable to define a blood pressure target in frail and institutionalized elderly. Hypertension is a well stablished cardiovascular (CV) risk factor in adults, active independent older people and even in frail elderly; nevertheless in the group of frail elderly there is evidence that they might lack a benefit in the aggressive treatment of high blood pressure. The randomized controlled trials from Beckett N, et al. [1] and Briasoulis A, et al. [2] showed that the hypertension treatment in older patients (age ≥65 years) and very old patients (≥80 years) significantly reduced CV morbidity and CV and all-cause mortality. In this studies treatment of hypertension was found to be well tolerated. The 2018 ESC/ESH guidelines recommend systolic blood pressure (SBP) target at 130-139 mmHg and diastolic blood pressure (DBP) under 80 mmHg for elderly above 65 years. The American guidelines (2017) recommend SBP under 130 mmHg for community dwelling older people above 65 years, but also recommend wariness in the risk-benefit relation, presence of comorbidities and limited life span. The Canadian guidelines (2018) refer to a lack of evidence to make a recommendation in blood pressure targets in institutionalized elderly [3]. The Australian guidelines (2016) recommend a target of SPB under 120 mmHg and the British (2017) omit a recommendation referring to targets in this population.

The reviews from Correa A, et al. [4] and Naschitz J, et al. [5] refer that in frail elderly with multiple comorbidities an individualized approach should be considered and the therapeutic targets and regimes should consider risks in this population, such as possible secondary effects, potential drug interactions and that there may be a need for deintensification of antihypertensive treatment [6,7]. A review from Ferri C [8] contemplates more aggressive targets in the eldery, for the author defend that hypertension is major CV risk factor and not its treatment. Nevertheless, the inclusion of frailty evaluation in clinical practice is of major importance to make decisions. The Systolic Blood Pressure Intervention Trial (SPRINT) (2015), showed that a SBP target under 120 mmHg for most elderly was reasonable. This trial included a significant amount of elderly participants above 75 years old and demonstrated that a more aggressive treatment significantly reduced major CV events, heart failure and all-cause mortality, all above 30%, with statistical significance, in comparison with standard treatment. This trial also suggests that this benefits may extend to frail elderly. Based on this trial, with outstanding results, the ESC/ESH taskforce made the new recommendations in the 2018 guidelines to people above 65 years. A cohort study by Corrao G, et al. (2017) [9], refers that adhesion to anti-hypertension treatment was associated with a reduction in the risk of CV events e CV mortality, even in ages above 85 years old.

Conclusion

Based on this review, we consider that there is recent evidence to support the definition of more strict targets in the elderly regardless of chronological age. However, we consider that frailty should be assessed in clinical practice with an evaluation tool and taken into consideration for an individualized approach in the treatment of hypertension.

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Iris Publishers- Open access Journal of Online Journal of Cardiology Research & Reports | Cardiac Rehabilitation and Endurance Exercise Improves Heart Health Behaviors and Health Status: Do Patients Adhere?

 

Authored by Lydia Albuquerque*

Abstract

World health organization has recognized Cardiac rehabilitation (CR) as a standard of care for prevention of cardiovascular disease such as cardiovascular mortality, cardiac death, stroke and non-fatal myocardial infarction. CR includes supervised training and self-care management recommended by the American Heart Association (AHA) and American College of Cardiology. Endurance type of exercise helps in improving the peak aerobic capacity (Peak VO2).

Keywords: Cardiac rehabilitation; Heart health behaviors; Health status; Adherence; Endurance

Introduction

The leading cause of non-transmittable death in 2015 was cardiovascular disease which account for 17.9 million deaths worldwide [1]. Cardiac Rehabilitation (CR) is a clinically recommended and highly effective model for managing all forms of chronic cardiovascular diseases and its secondary symptoms [2]. Through the collection of empirical evidence, it has been shown that CR programs reduce total mortality by 13-24% in the one to three years following the initial coronary event [1]. The goal of CR is secondary prevention, which aims to detect and intervene with the progression of cardiovascular disease so as to decrease mortality and morbidity rates among patients. It is a cost-effective preventative program consisting of physical training, cardiac education, as well as counseling for cardiac health and risk [3]. It was recognized in 1993 by the World Health Organization as the standard of care for prevention of cardiovascular disease factors such as cardiovascular mortality, cardiac death, stroke, and non-fatal myocardial infarction [4]. CR exercise training has shown to improve clinical outcomes among cardiac patient population [5]. CR includes supervised training and self-care management recommended by the American Heart Association (AHA) and American College of Cardiology (ACC) [6]. Endurance type of exercise helps in improving the peak aerobic capacity (Peak VO2) of heart failure patients [7]. The HF- ACTION (Heart failure: A controlled Trial Investigating Outcomes of Exercise training) demonstrated a reduction in all-cause mortality rate and depression and improved quality of life [5]. Patient post diagnosis of cardiac disease attend CR at least twice a week for over 4-6 months. Many patients will require CR to improve Heart- Health Behaviors (HHB) and Health Status [2]. Patient adherence to prescribed CR is directly related to outcome [3].

Phases of Cardiac Rehabilitation

CR is broken down into several different phases. Phase I takes place during the acute period of time following the cardiac event. It focuses on cardiac education and rehabilitation of regular movement for functional independence by the time the patient is discharged from the hospital [8]. Phase II consists of structured and organized outpatient physical therapy and exercises on a regular weekly schedule directed towards heart health and prevention of secondary disease [8]. Phase III consists of group focused exercise and education directed towards forming lessons from the previous stages into lifestyle habits. Phase IV, the last phase, is the patient’s own personal implementation of the exercises and information they have learned in the previous phases into their daily routines for the remainder of their lives [9]. The goal of all these phases, along with prevention of secondary symptoms, is to increase the health status of the patient [10] as well as their HHB [4].

Heart health Behavior & Health Status

HHB consists of the activities in a person’s life which effects the overall functioning of their heart. These are things such as whether or not a person smokes, keeps track of their blood pressure or hypertension, takes the necessary medications prescribed by their physician, has an unhealthy diet, or has sedentary life style. All these factors are a part of determining HHB [11]. Health Status is a multi-dimensional idea which is made up of many different indicators about the patient in question. One must take into account a person’s physical, emotional, and social states to accurately determine health status. This means that factors such as if a patient is diagnosed with a long term disease or sickness, if their medical records show history of specific past issues, if the patient has an emotional or mental illness diagnosis should all be taken into account when determining Health status. Health status is also determined through the help of how the patient views their own health [12].

Adherence to Cardiac Rehabilitation

Adherence is the extent at which a patient’s behavior corresponds with the suggested health recommendations from their physician. This can be anything from how often a patient remembers to take medication, to if they show up for their scheduled CR sessions, to whether or not a patient makes the recommended changes to their diet after release from the hospital [13]. Many different factors have been found responsible for the underuse and lack of adherence to CR programs. Factors such as old age and living at a distance greater than an hour from a rehabilitation center greatly impeded patients from participating in CR programs [10]. Patients with depression are seven times more likely to drop out of a CR program than those without depression. Patients who are single and have low social support have an increased risk factor of dropping out [1]. Lack of proper knowledge and perception of their disease [10] as well as being of a low socioeconomic status results in lower rates of adherence to programs [1]. Steps have been taken to try and address these factors and solve the issues which they present, such as suggesting free access to shuttle services for those who are a great distance from a CR center or are of low socioeconomic status. The implementation of providing heart risk education before CR begins for patients to understand the severity of the disease and increase attendance [1]. Another suggestion is for more in-home CR because those who did undertake in-home care showed greater rates of adherence to the program [3]. The suggestions to help increase adherence and attendance to CR programs are positive but they do not address the issue at present of knowing whether or not a patient’s adherence to a program has a direct positive or negative effect on their heart health behavior and overall health status.

Conclusion

A study completed in Ontario, Canada, [14], determined that the sooner a patient is referred and admitted into a CR program after serious cardiac disease, the more likely a positive outcome and lower possibility of negative complication will occur in the following year. Along with this evidence, the 2016 European Guidelines on cardiovascular disease states that the more closely one adheres to a CR program’s guidelines and treatment prescribed, the higher likelihood in preventing against secondary cardiovascular disease symptoms [15]. Despite the evidence that CR programs effectively reduce morbidity and mortality for cardiovascular disease patients, these programs are underutilized and lack patient adherence [1]. Based on the above review it is imperative to do further studies to elicit the effects of CR on HHB and health status of patients and explore the relationship of adherence to CR and its outcomes.

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Iris Publishers- Open access Journal of Online Journal of Complementary & Alternative Medicine | Self-Healing

 

Authored by Viviana Siddhi*

Short Communication

Effective healing is about self-mastery. Our body is a system of energy that we can operate in harmony or disharmony. The divine power that loves us enough to give us life challenges has the ability to wisely provide all that we need to resolve them in a good manner

Self-mastery is about creating and maintaining perfect health on a physical, emotional, mental and spiritual level, in a way that respects and harmonizes with all. If we know how to release all of the energy of negative emotions, then we learn how to be balanced.

“Alternatively, simply release all harmful vibrations with this affirmation: I now release all dross, all toxicity, all pollutants, all stress and all negative emotions stored in my cellular memory and everything that no longer positively serves me at this point in my life! Affirm: In joy, in safety, in harmony I step into the unknown. I willingly embrace all that is for my highest good [1].”

We need to have faith in the healing path, focus on fulfilling it and harmonizing ourselves back into health, faith that we can regain health. This is part of healing process. It is about having faith that our body has the innate intelligence to self-heal. If we feel our time is completed, we can exit consciously, however, it can also mean that we are on the crossway and we can choose different mission and continue to live in the same body. All we need to do is ask and then focus – with faith – on applying what we receive.

The journey of harmonious health is also the journey of enlightenment, as the light that we are in essence flows most brightly within us the more we are in harmony within. The more it flows, the healthier and happier we become. Having the faith in its-ability to heal us is a challenge that we all face from time to time, for everyone needs to be healed of something – whether it is deadly disease or feelings of loneliness, sadness or separation or the mental illness or greed or jealousy or the spiritual illness of “one way, my way” and self-righteous behavior.

If you are healthy and your chakras are all healthy we are able to maintain healthy body, mind and spirit. “Closing second chakra in response to emotional or sexual issues destabilizes your energy center that houses your emotions and your gender sexuality, you cannot move beyond your difficulties. How can you, when this basic life energy, healing ability, and information is unavailable to you?” [2].

When the second chakra is open and flowing with healthy, clear, warm orange energy, the body has a peaceful and sensual fluidity. It confers an emotive, responsive connection to nature, to animals and humans, to the self, and to the spiritual world. A healthy gender balance creates deeply nurturing, focused, and capable people who are also spiritually aware and emotionally responsive. People with healthy second chakra have a very deep understanding of the flow of events and people around them. By connecting to their own emotions, they connect to the world.

Energy troubles in your aura are a reflection of what is going on in your life, but the root cause of the troubles can usually be found inside your chakras. Keep grounding. Keep things simple. Go back to the place where you were overwhelmed, and you will find that you can come at the issue differently. By keeping your feet on the ground, you will learn how to fly. When you fly over your own issues, you won’t have time to look down on other people.

“Life force is the central core of every enzyme, or you might say that enzymes are one of the vehicles through which life force works to make things happen.

Life force is the key to the spectacular feats of the yogis. It is said that some yogis have been able to live buried underground for weeks at a time. Some can heal a life-threatening disease by touching the patient. Others are able to prolong their lives for hundreds of years. They can, without effect, drink poisons that would kill an average person; cobra bites have no effect. All these feats are based upon their ability to control life force. [3]”

The aura is the radiant life force surrounding all living and socalled non-living substances of the Earth, such as water and rocks.

“The word “aura” is derived from the Greek aura meaning breeze because it is said to be continually in motion. It shimmers and alters in color depending on our thoughts, emotions and physical state. Muddy colors in the aura indicate negative emotions or ill health; clear colors are generally a positive sign.

Although psychics describe the aura differently (according to their own level of psychic perception), it is generally agreed that the aura is composed of at least three layers or levels. These levels vibrate at different frequencies. The physical body or matter vibrates at the slowest or densest frequency; the subtle body, like electricity, vibrates much faster and for this reason we are usually unaware of its existence.

“The function of etheric body is to receive and transmit energy or life-force (prana) from the air we breathe.” [4]

“We are all born with a vital energy life force. In its microcosm, it can be understood on an atomic level in terms of the cellular structure, as the very essence and core of our existence. The specific energy areas discussed are related to basic human needs and emotions. We will focus on the basic human needs to be loved, close, intimate, and warm, and the basic human feelings such as fear, sadness, anger, pain, anxiety, and hopelessness.

The body-mind constantly strives for balance, harmony, and homeostasis. When a force acts upon the body-mind from within or without, there is a reaction, and the entire system may be affected. The homeostatic forces are constantly in operation, seeking to create the necessary exchanges to maintain the vital life force [5].”

Toxicity in the form of acidic waste is the primary cause of degenerative disease. Pure air is invigorating because with the acidic, toxic pollutants removed, it carries more oxygen. This additional oxygen is transported by the blood to the cells, where the process of respiration into energy converts it. Increasing the body’s energy level not only promotes a sense of well-being but also enables the metabolic processes within the body to work efficiently in eliminating the acidic wastes that lay the groundwork for degenerative disease.

“When you sleep on a magnetic pad or place a magnet anywhere on your body, the positively charged ions in the iron in the blood are attracted to the negatively charged ions emitted by the magnet. This increases the blood supply in the area, and this increased blood flow oxygenates the tissues, reducing acid wastes and the inflammation they cause. Dr.Philpott says that he has normalized high blood pressure in individuals with magnetic sleeping pads, which lower blood pressure by removing the fatty plaque buildup on artery walls [6].”

Diet advocates a sensible food-combination program in conjunction with herbal medicine therapies to balance the positively charged acidic particles in the body with the negatively charged particles.

Ayurveda teaches that each individual has the power to heal himself. This science of life offers everyone the freedom to recover health by understanding the body and its needs.

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