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Managing social and cultural expectations As well as coping with physical and emotional changes mental health awareness week loxitane 25 mg without prescription, women have had to learn how to manage the social and cultural expectations surrounding menopause mental illness 2013 purchase loxitane 25mg on-line. This is not as straightforward as it should be because there are many myths surrounding the topic rarest mental conditions purchase 25mg loxitane with visa, a sense of embarrassment and a feeling that mental health 24 generic 10mg loxitane otc, despite women being more open about menopause nowadays, it is still taboo. Eighteen of the 30 women spontaneously brought up the issue of menopause being taboo. It was described as a conspiracy of silence, an embarrassing problem and as having a shame factor. This belief is a paradox as these participants were clearly prepared to discuss menopause openly with the interviewer and yet simultaneously believed that menopause is not a topic for conversation. Several women expressed the view that previous generations were unwilling to acknowledge menopause although nowadays women were more open. Nevertheless, some of the participants were 165 aware of instances where women refused to acknowledge menopause or had husbands who disliked talking about emotional issues. Three explanations were suggested as to why menopause remains taboo: embarrassment, the associations with sex and synonymity with aging. Embarrassment reflects the illness belief in that women expressed concern that others would think they were unwell or incapable. One high treatment utiliser likened talking about menopause to being a bit like talking about thrush or something…. A low treatment utiliser stated that if you discuss symptoms you feel silly… like a hypochondriac (23). Furthermore, it is embarrassing to own up to bladder problems, vaginal dryness or low libido because this would mean admitting to no longer being fertile or sexually desirable. There is so much pressure on women now I think in the media to be sexually active and out there until they are 92 and off with young men or whatever they want to be off with. And you must be having a great time because now you know you can do what you like High treatment utiliser (30) However, the main reason for the taboo is related to the representation of menopause as being synonymous with aging and invisibility. Youth is revered and old people go unnoticed, are disrespected, and considered incompetent (Cuddy, Norton, & Fiske, 2005), Thus, admitting to being in menopause meant admitting to oneself and to others that one was old and no longer competent. Because I dont look 53, I probably look five or so years younger, a tiny bit younger. I dont look like a lot of women my age, although I think I have aged a lot (because of menopause) but when I am sitting around going pink in the face I am automatically put into the sort of young geriatric Low treatment utiliser (28) There were several ways that women choose to manage these expectations. They could be in denial, they could resist the stereotypes or they could accept and adapt. Being in denial could take the form of not being prepared to admit that one is entering menopause. This may be the underlying reason for the fact that so many women evinced surprise at the age of onset of menopause. It could also take the form of not admitting to being menopausal to others in case they made the type of assumption referred to by the participant above. Women expressed a fear that if they started talking about bits and bobs and saggy tits (26) others would lose respect for them or stop treating them as a friend and start thinking of them as an older auntie. Another strategy used was not to take menopause seriously and to make a joke out of it. Many acknowledged that there was a comedic element to menopause and that by joking about having a senior moment or my own personal summer the situation could be made more acceptable. It also 166 served as a code which women of a similar age would understand but which obviated the need to discuss anything more seriously. Despite all the negative connotations of aging females and menopausal bodies, there were signs of resistance. Women acknowledged the stereotype of women becoming batty and fat and zonky (22) at menopause whilst at the same time averring that this was untrue. They argued that they could ensure they were treated with respect, refuse to put up with rudeness and could assert their right to be noticed. For some, this meant actively fighting the aging process by maintaining a healthy diet, keeping a low bodyweight and remaining active. For others, fighting the aging stereotype was a question of keeping a young mindset in terms of how they approached their work and other people. Although the representation of menopause as symbolic of aging was important it did not predict symptom reporting. One reason for this may be the very interdependence of aging and menopause; women were simply unable to separate one from the other. Another possibility is that becoming invisible or disrespected is a general facet of aging but cannot be solely attributed to menopause. Adapting to menopause was discussed in the section on dealing with the emotional changes. It was evident that some women chose to fight menopause and aging whereas others, usually the low treatment utilisers, were more accepting of it. Part of acceptance was the recognition that menopause is a universal stage of life for women. Women across the world experience menopause and probably just get on with it and dont make an issue of it at all (10). Not labelling menopause as an illness but as a temporary, transitional phase was an important aspect of positioning menopause as a normal stage of life. I think they suffered just as much but they dont – they think it is natural, I just have to go through it High treatment utiliser (17) Taking control by taking things into your own hands was a key component of adapting to menopause, as was acquiring more information and better understanding of the situation. One woman commented that the consequence of menopause remaining taboo and not openly discussed was that others (usually men) framed the debate and made decisions on behalf of women. A further consequence of the taboo status of menopause was, of course, poor or incorrect knowledge and the promulgation of myths. For example, one woman said that hormone therapy can make women go bald and, as noted earlier, several continued to believe that women go mad at menopause. The critical issue for women in terms of being able to accept or adapt to the changes was that women had no benchmark of normality. Inadequate knowledge, the lack of open discussion, and a failure to set expectations meant that the most frequently asked question was is this normal Erm so only really since then and Ive been trying to piece things together and what about this and looking back that I have made those link High treatment utiliser (5) the quote above is typical of the type of issues raised by women concerning normality. This was the main reason for comparing their own experiences with other women; to find out whether others had the same or different symptoms and to discover whether they were better or worse. The result of this extensive process of comparison was, more often than not, more confusion. Women quickly discovered that some women had much worse problems, such as having to change sheets in the middle of the night, and some women barely noticed any changes. Some women had flushes for a few months whilst some women had hot flushes into their seventies. It was the uncertainty that was the main source of worry for women, and uncertainty was the main reason for the search for a benchmark of normality. The questions women wanted answered were At what age should I expect to start menopause The failure of clinicians to provide some degree of certainty was a primary cause of the loss of faith in the medical profession in terms of advice provided about menopause. Discussion Diaries and interviews were instrumental in helping women to describe their experiences. This process highlighted that menopause is more than a physiological change brought about by a decline in hormones but is also experienced socially, psychologically and culturally. The biological experience was most closely associated with vasomotor symptoms and changes to sexual activity and desire. The psychological experience of menopause was highly emotional because it was linked to concepts of aging and loss of fertility. For this reason, some women felt unable to accept the new situation and would actively fight it. It was often difficult for women to know whether to attribute changes to menopause or to general aging and low levels of knowledge about what to expect at menopause made attributions more difficult. Furthermore, emotional responses were intertwined with 168 physical experiences so that there could be a vicious spiral whereby a severe physical symptom prompted an emotional response which in turn prompted a severe physical symptom and so on. Most women get their knowledge from other women though mothers were instrumental in inter-generational transmission of the idea that women should expect to be ill at menopause.

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Understand the factors associated with electrophysiologic study (eg disorders of the brain generic 25 mg loxitane amex, indications mental disorders related to diabetes purchase loxitane 10mg overnight delivery, contraindications mental health treatment grants discount loxitane 10 mg without a prescription, risks mental illness unable to make decisions 25mg loxitane fast delivery, and limitations) and catheter- or surgical- based ablation therapy for orthodromic reentry via accessory pathway 3. Recognize and manage the consequences of orthodromic reentry via accessory pathway 9. Recognize the clinical features of the permanent form of junctional reciprocating tachycardia 2. Differentiate the permanent form of junctional reciprocating tachycardia by surface electrocardiographic criteria 3. Recognize intracardiac electrophysiologic characteristics of the permanent form of junctional reciprocating tachycardia b. Understand the mechanisms and natural history of the permanent form of junctional reciprocating tachycardia c. Recognize and medically manage the permanent form of junctional reciprocating tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) 2. Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical- based ablation therapy for the permanent form of junctional reciprocating tachycardia 3. Recognize and manage the consequences of the permanent form of junctional reciprocating tachycardia 10. Recognize intracardiac electrophysiologic characteristics of antidromic reentry b. Recognize and medically manage antidromic reentry in patients of varying ages (eg, fetus, infant, child, adolescent, young adult) 2. Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical- based ablation therapy for antidromic reentry 3. Recognize clinical features associated with accessory atrioventricular connection or pre-excitation syndromes b. Recognize associated cardiac defects in a patient with an accessory atrioventricular connection 2. Recognize characteristics of accessory atrioventricular connections or pre-excitation syndromes based on electrophysiologic studies 4. Know the natural history of accessory atrioventricular connections or pre-excitation syndromes 5. Plan the management of patients with accessory atrioventricular connections or pre-excitation syndromes E. Distinguish the clinical features of benign ventricular ectopy and distinguish from more serious ventricular arrhythmias 2. Know the differential diagnosis of benign ventricular ectopy on electrocardiogram 4. Identify the specific electrocardiographic features of diseases associated with benign ventricular ectopy b. Distinguish the clinical features of benign idiopathic outflow tract ventricular ectopy 2. Know the differential diagnosis of idiopathic outflow tract ventricular ectopy on electrocardiogram b. Understand the mechanisms and natural history of idiopathic outflow tract ventricular ectopy c. Distinguish the clinical features of scar-related macroreentrant ventricular tachycardia 2. Know the differential diagnosis of scar-related macroreentrant ventricular tachycardia on electrocardiogram 4. Identify the specific electrocardiographic features of diseases associated with life-threatening scar-related macroreentrant ventricular tachycardia b. Understand the mechanisms and natural history of scar-related macroreentrant ventricular tachycardia c. Know the differential diagnosis of ventricular tachycardia in cardiomyopathy on electrocardiogram 3. Identify the specific electrocardiographic features of diseases associated with life-threatening ventricular tachycardia in cardiomyopathy b. Understand the mechanisms and natural history of ventricular tachycardia in cardiomyopathy c. Distinguish the clinical features of benign catecholaminergic polymorphic ventricular tachycardia 2. Know the differential diagnosis of catecholaminergic polymorphic ventricular tachycardia on electrocardiogram 4. Identify the specific electrocardiographic features of diseases associated with life-threatening catecholaminergic polymorphic ventricular tachycardia b. Understand the mechanisms and natural history of catecholaminergic polymorphic ventricular tachycardia c. Identify the specific electrocardiographic features of diseases associated with life-threatening right ventricular cardiomyopathy b. Know the differential diagnosis of torsade de pointe ventricular tachycardia on electrocardiogram 4. Identify the specific electrocardiographic features of diseases associated with life-threatening torsade de pointe ventricular tachycardia b. Understand the mechanisms and natural history of torsade de pointe ventricular tachycardia c. Know the mode of transmission, application, and interpretation of genetic tests of inherited channelopathies 3. Understand the indications for implantation of an intracardiac device for inherited channelopathies c. Understand the potential role of cardiac sympathectomy in management of channelopathies G. Recognize noncardiac diseases associated with atrioventricular block (eg, mitochondrial myopathy, myotonic dystrophy) d. Recognize acquired cardiac diseases associated with atrioventricular block (eg, Lyme disease). Know the natural history of atrioventricular block of various causes (eg, congenital, acquired, surgically induced) 3. Plan appropriate management of atrioventricular block of various causes (eg, congenital, acquired, surgically induced) H. Know the indication for permanent pacer implantation in sinus node dysfunction 15. Know the risk factors and cardiac and noncardiac lesions that have the highest risk of bacterial endocarditis 2. Recognize the signs and clinical manifestations of infective endocarditis and the symptoms of bacterial endocarditis resulting in left-heart versus right-heart endocarditis 4. Recognize the symptoms of bacterial endocarditis resulting in left-heart versus right- heart endocarditis 5. Identify the extracardiac manifestations and complications of endocarditis and understand their mechanism(s) of development 7. Know the current status and duration of therapy of antimicrobial therapy of infective endocarditis 10. Know the common reasons why endocarditis may yield negative results of a culture 11. Know the role of cardiac catheterization and endomyocardial biopsy in diagnosis and management of myocarditis 3. Formulate the differential diagnosis of an enlarged cardiac silhouette in a febrile child 6. Formulate the differential diagnosis of an enlarged, poorly contractile left ventricle 7. Know gross and histologic features of major cardiovascular inflammatory disease 9. Recognize myocarditis cardiac manifestations of systemic cardiac disease (eg, rheumatoid arthritis, Kawasaki disease, sepsis) 10. Know pathologic features and clinical cardiovascular manifestations of Kawasaki disease 2. Know the sequence and time of appearance of cardiac lesions associated with Kawasaki disease 3. Understand the indications for and the role of diagnostic imaging in initial diagnosis and management of Kawasaki disease, including patients with atypical presentation 4. Know the sequence and timing of noncardiac findings associated with Kawasaki disease 5.

Their sexual experiences had always been pleasurable and free of problems until two years ago zinc mental disorders cheap 10mg loxitane with mastercard. Immediately after the birth of their second child mental disorders of disney characters cheap 25mg loxitane, she experienced persistent pain whenever intercourse was attempted mental disorders related to social media loxitane 10mg cheap. The pain was located at the entrance to her vagina and became evi- dent only with entry mental treatment 99203 discount 25mg loxitane with visa. Before her vaginal pain began, the frequency of intercourse was several times each week but now was reduced to once or twice each month. She and her husband remained sexually interested and sexual activity (excluding, by agree- ment, attempts at intercourse) occurred several times each week. The use of tampons had never been a source of diffculty for her but she stopped using them after her last childbirth. Vaginal examinations by her doctor were uncom- fortable in the past but now they were associated with great pain. At her request her husband stopped inserting his fnger into her vagina during sexual experiences. On examination by a gynecologist, there was vaginal spasm at the introitus and mild reddening in the 4 to 9 oclock area of the vestibule. The cotton swab test (see Figure 13-2 and `Physical Examination below in this Chapter) showed exquisite tenderness in this same region, indicating a diagnosis of vulvar vestibulitis. Anesthetic ointment relieved her pain temporarily but also diminished pleasur- able feelings. Vaginal dilators helped relieve the vaginal spasm so that when inter- course occurred it was less painful. Surgery was discussed with her and while she and her husband viewed this as a possible option, they preferred to wait until other approaches were exhausted. A 23-year-old school teacher was seen with her husband of eight months because intercourse was attempted on many occasions but had never actually occurred (either during her marriage or before). Both were born of families that emigrated from Asia and had known each other since childhood. The marriage was born of a love relationship rather than having been arranged but they nevertheless refrained from including intercourse in their sexual activities before their wedding because of family, religious, and cultural proscriptions. Both families were applying not-so- subtle pressure on the couple to have children. She was terrifed of pain and expected to experience pain with anything entering her vagina (or going out, hence also her fear of childbirth). Her dread of pain with intercourse was so strong that she cried out when he neared her vulva (a reaction that made him progressively less enthused about making any attempt at vaginal entry). In an initial inspection-oriented pelvic examination, the patient was in a semi- reclining position and watched the procedure with a handheld mirror. When on a subsequent occasion the end of the physicians fnger was introduced into the patients vagina, the physician could feel a ring of sur- rounding muscle. The diagnosis of vaginismus was made and the patient and her husband began a treatment program. About four months later, intercourse occurred successfully on many occasions, and when last seen she was pregnant. The r M i n o l o g y Terminology problems have more to do with health professionals than with patients or the lay public. Dyspareunia is more specifc in describing pain associated with sexual intercourse. Dyspareunia could be felt at the point of vaginal entry, associated with the back and forth movements of intercourse, or deep within the patients vagina. Insofar as pain with intercourse is discussed, this chapter concerns itself principally with the frst. However, patients may complain of vaginal discomfort, rather than pain, when intercourse occurs. Whether such discomfort always represents mild pain, does so sometimes, or is something else altogether is unclear. The multiplicity of problems that are inherent in the present use of the word dyspareunia were outlined by Meana and Binik and include issues such as unclear defnition, disagreement over the inclusion or exclusion of certain disorders (such as vaginismus and postmeno- pausal vaginal dryness), confusion about the role of physical and psychological fac- tors in the etiology, and the meaning of not fnding abnormalities on pelvic exami- 1 nation. Another source of confusion can be found in the use of the word vaginismus, which in the literature describes (1) a physical sign accompanying various casuses of painful intercourse and (2) a specifc disorder. For example, when intercourse is attempted in the context of vaginismus, patients usually complain of pain (although fear of pain may be much more prominent). Likewise, when persistent painful intercourse occurs for reasons other than vaginismus, it is clinically commonplace to see associated vagi- nal spasm. In such instances, vaginal spasm seemingly functions as a symptomatic and defensive (usually involuntary) reaction of the woman to protect herself against antic- ipated pain. In clinical practice, the frst two patterns described below are most commonly seen; the third probably occurs frequently in the community but is uncommonly presented to health professionals. The assessment of pain, discomfort, or fear associated with attempts at intercourse in women is outlined in Figure 13-1. Not only has a mans penis never entered her vagina, but the same story is also heard concerning her own, or her partners fngers, tampons or a physicians fngers or speculum. Alternatively, vaginal entry of a current or previous partners penis may have taken place but pain persisted through much of the experience of intercourse. In a frenzy of ambivalence, she may have explicitly suggested to her partner that he fnd himself someone else while simultaneously fearful that he will do exactly that. The agony of feeling unable to become pregnant through intercourse is often the fnal straw that drives her to the humiliating admission that help is necessary to accom- plish what television, magazines, and billboards shout is a common event for the rest of mankind. A 22-year-old woman saw her family doctor because she had married three weeks before but was unable to have intercourse despite numerous attempts. It was evi- dent that she was fearful of vaginal entry but it was not evident whether she also experienced pain when intercourse was attempted. She and her husband were sex- ually active with one another in the three years of their courtship but decided for religious reasons that intercourse should be included only after they married. Their sexual practices did not include vaginal insertion of his fngers, and, as well, she never had intercourse with a previous sexual partner, did not like the idea of tam- pons, and never had a vaginal examination from a physician. Neither she nor her husband described any other diffculties with their sexual function. A pelvic examination was scheduled for the following day when the physician could allocate a greater amount of time. The external vulvar examination revealed no structural pathology and a negative swab test. The physician then explained her diagnostic impression of vaginismus and aspects of the anatomy and physiology of the patients vagina, reassured the patient that there were no apparent structural problems impeding intercourse, described the importance of control by the patient in relation to vaginal insertion, and encouraged the patient to insert her own and then the doctors fnger part-way into her vagina. She was encouraged to guide her hus- bands penis into her vagina in the same manner as her own fnger. When seen one week later, the patient related that intercourse occurred on three occasions, the last two times without any diffculty. A 38-year-old woman was seen alone because of a lifelong inability to have inter- course. Her frst marriage was annulled after fve years, primarily because of non- consummation. Over the years, she was unwilling to accept suggestions made by her family physician (aware of the problem because of the impossibility of vaginal examinations) for referral to a sex therapist. Presently, she was in the midst of a serious relationship and was contemplating marriage. However, she was also fearful of the implications of her inability to engage in intercourse. Her partner was accepting of this limitation but at the same time was encouraging her to obtain medical care. She remained unwilling to consult a sex therapist and insisted on not involving her partner in the treatment pro- gram, explaining that she had this problem long before their relationship began. She was unable to insert the smallest dilator and felt pessimistic about the beneft of this approach.

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Thats 2 hours and 30 minutes mental therapy 4 fishing order loxitane 10mg, about the same amount of time you might spend watching a movie mental health questionnaires buy 10 mg loxitane with amex. The good news is that you can spread your activity out during the week disorders of brain-eating parasite generic loxitane 10 mg mastercard, so you dont have to do it all at once mental health 63090 loxitane 25 mg fast delivery. Its about what works best for you, as long as youre doing physical activity at a moderate or vigorous effort for at least 10 minutes at a time. If you cant set aside 30 minutes or more at one time to be active, you can break your activity into shorter periods of at least 10 minutes. For example, you can • Park your car farther away and walk to your office, or take the stairs instead of the elevator. If done before and after work, this change could equal 10 minutes of physical activity each workday. Remember, whatever activity you choose to do, be physically active, at least 150 minutes a week. You may fnd that you might need to be active more than 150 minutes a week to lose weight or to maintain a weight loss. Children and teenagers should be getting 60 minutes of activity throughout their entire day. For adults 65 years of age and older, regular physical activity is one of the most important things you can do for your health. It also helps your muscles grow stronger, so you can keep doing your day-to-day activities without becoming dependent on others. Not doing any physical activity can be bad for you, no matter your age or health condition. Your health benefts will also increase with the more physical activity that you do. If youre 65 years of age or older, are generally ft, and have no limiting health conditions you should aim for 150 minutes of physical activity a week. Ask Is it okay for women to be physically active while they are pregnant and after they have their babies If women are healthy while pregnant and after they have had babies, physical activity is good for their overall health. For example, moderate- intensity physical activity, such as brisk walking, keeps your heart and lungs healthy during and after pregnancy. After you have your baby, exercise helps maintain a healthy weight, and when combined with eating fewer calories helps with weight loss. Talking Points A simple method for measuring intensity of an activity is the talk test. If you become too winded or too out of breath to talk to others, the intensity level of the activity is high. Point out activities that can be done at different intensity levels, such as housework, golf, swimming, and bicycling. You may remember from an earlier session that we get nutrients and energy from the food we eat. The more calories in a food, the more energy or activity it takes to burn those calories. Some examples might be • If a person has been inactive for a while, encourage him or her to start slowly. He or she should start out with as little as fve minutes of walking at a time and then slowly more add minutes to that time, until they each at least 150 minutes a week, • Help people choose physical activities theyll enjoy. How Community Health Workers Can Help Create More Physically Active Communities Talking Points There are many ways that you can help people in your community who are at risk for heart attack and stroke to be more physically active. For example • Know the locations of walking trails, parks, and other places to walk in your community. To learn more about programs in your state for promoting physical activity and reducing obesity, visit the Web site of the Centers for Disease Control and Preventions State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases at. Tell them that encouraging and helping people to be active is very important for the health of their community. Remind them that they can play a vital role in helping to shape community policies and to create an environment that encourages active lifestyles for all community members. This might include • Explain the benefts of physical activity to community members. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention My Personal Physical Activity Plan Activity 13–2 My goal is to spend minutes per week in physical activity. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Make Physical Activity a Habit Activity 13–3 My Personal Log Name Fill this in every day so you can see how you are doing each week. Sunday Monday Tuesday Wednesday Thursday Friday Saturday Example 5 mins 5 10 10 15 15 15 Week 1 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Ways to Add Physical Activity to Your Daily Life Activity 13–4 There are 1,440 minutes in every day. With a little creativity and planning, even the person with the busiest schedule can make room for physical activity. For many folks, before or after work or meals is often a good time to walk, or play. Think about your weekly or daily schedule and look for or make ways to be more active. Consider these ideas • Walk or cycle to work, school, the store, or your place of worship. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Walking Tips Activity 13–5 Why walk If you can talk as easily while walking as you can while standing still, you may want to go a little faster. Plan where you will walk before you go and think about fat places near your home, such as shopping malls, school tracks, or your street. Find a walking partner, or if you do walk alone, make sure someone knows when and where you are walking. Wear loose-ftting clothes and comfortable, well-cushioned athletic or walking shoes. If you miss more than 3 days of walking, decrease your time and begin again slowly. If you have warning signs, such as an uncomfortable feeling of constant pressure, pain, or fullness or squeezing in the chest, shortness of breath, nausea,, light- headedness, abnormal heartbeat, or any other signs of trouble, get medical help immediately! Call 9-1-1, the emergency rescue service, or have someone drive you to the nearest hospital with cardiac emergency care. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Some Examples of Activities and Their Intensity Levels Activity 13–6 Moderate activities • Your heart beats faster than normal • You can talk but not sing Vigorous activities • Your heart rate increases a lot • You cant talk or talking is broken up by large breaths Moderate-Intensity Activities • Fast walking • Swimming slowly • Mowing lawn (using a power motor), raking and bagging leaves • Tennis (doubles) • Bicycling 5 to 9 mph on level roads or with a few hills • Scrubbing foors or washing windows • Strength training (using machines or free weights) • Actively playing with kids Vigorous-Intensity Activities: • Racewalking, jogging, or running • Swimming steady laps • Mowing the lawn (using a hand mower) • Tennis (singles) • Bicycling more than 10 mph, or on steep uphill roads • Moving or pushing furniture • Circuit training Videos these videos help explain the guidelines, give you tips on how to meet them and show you how to do muscle strengthening exercises properly. Begin with an active hobby or way of playing a sport or I do not enjoy being active. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention What Can Communities Do to Support Physical Activity Activity 13–8 In the community • Ask for simple signs that point to stairs, and encourage people to take the stairs instead of elevators. In worksites • Ask for policies that allow employees to use work time for healthy activities, such as walking. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention Tobacco Control 14 Objectives By the end of this session, community health workers will be able to • List the harmful effects of smoking. Activities • 14–1: How Smoking, Second Hand Smoke and Chewing Tobacco Can Harm You • 14–2: Role Play: How to Ask Someone to Not Smoke Around You • 14–3: Are You Ready to Stop Smoking In the United States, cigarette smoking kills more than 480,000 people each year from diseases related to smoking. Also, another 41,000 people die each year because they were exposed to secondhand smoking (smoking by others around them). Talking Points: Tobacco contains more than 7,000 other chemicals: 70 of these chemicals are known to cause cancer. They include • Carbon monoxide (the same chemical that exists in car exhaust fumes). When you smoke, you breathe in a number of chemicals, one of which is carbon monoxide. Carbon monoxide keeps blood cells from taking in the oxygen that the rest of your body needs to keep you healthy. When you use tobacco products, a chemical called nicotine quickly goes into your bloodstream.

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