IMPORTANT NOTE: JAAPA CME activities consist of 2 articles. To obtain credit, you must also read
Hip resurfacing: A fresh look at an alternative to total joint arthroplasty; the post-test will include questions related to both articles. AAPA Fellow members should complete and submit the post-test on the AAPA Web site by going to
www.aapa.org and searching for keyword
JAAPA post-tests. All others may complete and submit the post-test online at no charge at
www.mycme.com. To obtain 1 hour of AAPA Category I CME credit, PAs must receive a score of 70% or better on each test taken.
KEY POINTS
■ As early as 1925, Hans Selye observed the physiologic effects of stress. Based on his observations, Selye theorized that when animals were exposed to stressors they exhibited a consistent response pattern, which he called the general adaptation syndrome (GAS).
■ GAS is a series of three events that occur when the body is exposed to acute and chronic levels of stress. The alarm stage is a “fight-or-flight” reaction in which hormones that increase defensive capabilities are released. In the stage of resistance, the body continues its defense by maximizing hormone release, thereby decreasing resistance against other simultaneous stressors. During the disease of adaptation, the stressor consumes all of the person's energy, forcing the body into a state of exhaustion.
■ Stress as a factor in the causation of diseases often goes unrecognized by the medical community. The lack of recognition often occurs when patients present with multiple somatic complaints but have no underlying pathology.
■ When discussing stress management options with patients, suggesting a wide variety of activities is important; this allows the patient to experiment and find an activity that best fi ts his or her needs and schedule.
Stress is a growing public health concern. It can have both physical and psychological affects on many people. According to the American Psychological Association (APA), the nation's declining economy is taking a physical and emotional toll on Americans nationwide as personal stress levels continue to rise.1 Many people are able to cope with small exposures
to psychologic stressors, and some people even become more productive when under pressure. However, stress becomes problematic when it is overwhelming and a person begins to experience adverse physiologic consequences2 (Table: Physiologic consequences of stress in the online version of this article).
The APA conducts an annual survey that explores stress and its impact across the country. In 2009, 24% of adult respondents reported experiencing high levels of stress and 51% reported moderate stress levels.1 Furthermore, men and women were affected by stress differently. Overall, women reported higher levels of stress; were more likely than men to cite various stressors, such as economic problems and health concerns; and reported more physical and emotional symptoms as a result of stress.1 Although financial problems were the greatest source of stress for most Americans, other stressors produced by the declining economy were reported as significant by two-thirds of respondents1 (Table 1).
The APA survey also measured attitudes and perceptions of stress among the general public and identified leading sources of stress, common behaviors used to manage stress, and the impact of stress on Americans. The serious physical and emotional manifestations reported in the survey results demonstrate the link between the mind and the body. Almost half of respondents reported that the level of stress in their lives has significantly increased over the past year, and as many as 24% of respondents rated their average stress level as 8 to 10 on a 10-point scale (where 10 equals a great deal of stress).
Although 81% of those surveyed believed that they were managing their stress well, respondents reported that they continued to experience physical and emotional symptoms as well as a negative effect on their relationships, work productivity, and personal lives. In fact, half of those surveyed acknowledged that they were not doing enough or were not sure if they were doing enough to manage their stress effectively.2 Furthermore, few respondents who received recommendations on how to manage stress from their health care providers reported that the providers offered support to help them make lasting changes; 46% of respondents were given an explanation of the lifestyle change recommendation, 5% were offered advice or shown techniques for making the change, and only 5% to 10% were referred to another health care provider to support the adoption of lifestyle changes.1
The negative effects of stress have been investigated for many years. As early as 1925, Hans Selye observed the physiologic effects stress has on a person. His initial work focused on analyzing the adverse reactions laboratory animals demonstrated when stimulated by noxious agents. Based on his observations, Selye theorized that when animals were exposed to stressors they exhibited a consistent response pattern, which he called the general adaptation syndrome (GAS).3