CONCLUSION
In today's fast-paced society, stress is unavoidable. Financial worries, job loss, arguments or strained relationships, traffic, personal disappointments, and even inclement weather occur every day, and these stressors may have a profound impact especially if the person is exposed to several stressors simultaneously. The end result of chronic stress is exhaustion, which can make patients susceptible to any of the disease states discussed above. Clinicians are not immune to the effects of stress either. Clinicians need to work with their patients to find the stress management strategy that will provide the most effective help in dealing with the fast paced, ever-changing environments in which we live. The hope is that the end result will be the prevention of illness and disease. JAAPA
Denise Rizzolo is a physician assistant at the Care Station in Springfield, New Jersey. She is also an assistant professor in the physician assistant program at Seton Hall University, South Orange, New Jersey. Mona Sedrak is an associate professor and program director in the physician assistant program at Seton Hall University. They have indicated no relationships to disclose relating to the content of this article.
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.
REFERENCES
1. Stress in America 2009. Washington, DC: American Psychological Association; 2009.
2. Stress in America. Washington, DC: American Psychological Association; 2008.
3. Selye H. The general adaptation syndrome and the disease of adaptation. J Clin Endocrinol. 1946;6(2):117-120.
4. Matthews KA, Katholi CR, McCreath H, et al. Blood pressure reactivity to psychological stress predicts hypertension in the CARDIA study. Circulation. 2004;110(1):74-78.
5. Everson SA, Lynch JW, Kaplan GA, et al. Stress-induced blood pressure reactivity and incident stroke in middle-aged men. Stroke. 2001;32(6):1263-1270.
6. Jennings JR, Kamarck TW, Everson-Rose SA, et al. Exaggerated blood pressure responses during mental stress are prospectively related to enhanced carotid atherosclerosis in middle-aged Finnish men. Circulation. 2004;110(15):2198-2203.
7. Treiber FA, Kamarck T, Schneiderman N, et al. Cardiovascular reactivity and development of preclinical and clinical disease states. Psychosom Med. 2003;65(1):46-62.
8. Herd JA. Cardiovascular response to stress. Physiol Rev. 1991;71(1):305-330.
9. Ming EE, Adler GK, Kessler RC, et al. Cardiovascular reactivity to work stress predicts subsequent onset of hypertension: the Air Traffic Controller Health Change Study. Psychosom Med. 2004;66(4):459-465.
10. Alan MT, Stoney CM, Owens JF, Matthews KA. Hemodynamic adjustments to laboratory stress: the influence of gender and personality. Psychosom Med. 1993;55(6):505-517.
11. Anderson NB. Racial differences and stress-induced cardiovascular reactivity and hypertension: current status and substantive issues. Psychol Bull. 1989;105(1):89-105.
12. Raikkonen K, Matthews KA, Kuller LH. Depressive symptoms and stressful life events predict metabolic syndrome among middle aged women. Diabetes Care. 2007;30(4):872-877.
13. Goldbacher EM, Matthews KA, Salomon K. Central adiposity is associated with cardiovascular reactivity to stress and adolescence. Health Psychol. 2005;24(4):375-384.
14. Barnett PA, Spence JD, Manuck SB, Jennings JR. Psychological stress and progression of carotid artery disease. J Hypertens. 1997;15(1):49-55.
15. Matthews KA, Owens JF, Kuller LH, et al. Stress-induced pulse pressure change predict women's carotid atherosclerosis. Stroke. 1998;29(8):1525-1530.
16. Detrano RC, Wong ND, Doherty TM, Shavelle R. Prognostic significance of coronary calcific deposits in asymptomatic high-risk subjects. Am J Med. 1997;102(4):344-349.
17. Arad Y, Spadaro LA, Goodman K, et al. Predictive value of electron beam computed tomography of the coronary arteries. 19-month follow-up of 1173 asymptomatic subjects. Circulation. 1996;
93(11):1951-1953.
18. Pletcher MJ, Rice JA, Pignone M, Browner WS. Using the coronary artery calcium scores to predict coronary heart disease events: a systematic review and meta-analysis. Arch Intern Med. 2004;164(12):1285-1292.
19. Matthews KA, Zhu S, Tucker DC, Whooley MA. Blood pressure reactivity to psychological stress and coronary calcification in the Coronary Artery Risk Development in Young Adults study. Hypertension. 2006;47(3):391-395.
20. Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288(21):2709-2716.
21. Laaksonen DE, Lakka HM, Niskanen LK, et al. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol. 2002;156(11):1070-1077.
22. Ford ES, Giles WH, Dietz WH. Prevalence of metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356-359.
23. Rozanski A, Blumenthal JA, Davidson KW, et al. The epidemiology, pathophysiology, and management of psychosocial risk factors and cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol. 2005;45(5):637-651.
24. Evans DL, Charney DS, Lewis L, et al. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry. 2005;58(3):175-189.
25. Volkmann ER, Weekes NY. Basal SIgA and cortisol levels predict stress-related health outcomes. Stress Health. 2006;22(1):11-23.
26. McClelland DC, Floor E, Davidson RJ, Saron C. Stressed power motivation, sympathetic activation, immune function, and illness. J Human Stress. 1980;6(2):11-19.
27. Levenstein S. The very model of a modern etiology: a biopsychosocial view of peptic ulcer. Psychosom Med. 2000;62(2):176-185.
28. Levenstein S, Ackerman S, Kiecolt-Glaser JK, Dubois A. Stress and peptic ulcer disease. JAMA. 1999;281(1):10-11.
29. Nepomnaschy PA, Sheiner E, Mastorakos G, Arck PC. Stress, immune function, and women's reproduction. Ann N Y Acad Sci. 2007;1113:350-364.
30. Boivin J, Takefman JE. Stress level across stages of in vitro fertilization in subsequently pregnant and nonpregnant women. Fertil Steril. 1995;64(4):802-810.
31. Beutel M, Kupfer J, Kirchmeyer P, et al. Treatment-related stresses and depression in couples undergoing assisted reproductive treatment by IVF or ICSI. Andrologia. 1999;31(1):27-35.
32. Boivin J, Scanlan LC, Walker SM. Why are infertile couples not using psychosocial counseling? Hum Reprod. 1999;14(5):1384-1391.
33. Berns JL. Adult depression: treatment by subtype for success. Clinical Advisor. 2010;13(2):47-56.
34. Smith C, Hancock H, Blake-Mortimer J, Eckert K. A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complemen Ther Med. 2007;15(2):77-83.
35. Malathi A, Damodaran A. Stress due to exams in medical students—role of yoga. Indian J Physiol Pharmacol. 1999;43(2):218-224.
36. West J, Otte C, Geher K, et al. Effects of hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Ann Behav Med. 2004;28(2):114-118.
37. Malathi A, Damodaran A, Shah N, et al. Effect of yogic practices on subjective well being. Indian J Physiol Pharmacol. 2000;44(2):202-206.
38. Schell FJ, Allolio B, Schonecke OW. Physiological and psychological effects of Hatha-Yoga exercise in healthy women. Int J Psychosom. 1993;41(1-4):46-52.
39. Kuiper NA, Martin RA, Olinger LJ. Coping humour, stress and cognitive appraisals. Can J Behav Sci. 1993;25(1):81-96.
40. Fry WF. The biology of humor. Humor. 1994;7(2):111-126.
41. Newman MG, Stone AA. Does humor moderate the effects of experimentally-induced stress? Ann Behav Med. 1996;18(2):101-109.
42. Sandlund ES, Norlander T. The effects of tai chi chuan relaxation and exercise on stress responses and well-being: an overview of research. Int J Stress Manag. 2000;7(2):139-149.
43. Shapiro SL, Astin JA, Bishop SR, Cordova M. Mindfulness-based stress reduction for health care professionals: results from a randomized trial. Int J Stress Manag. 2005;12(2):164-176.
44. What is mindfulness-based stress reduction? http://www.mindfullivingprograms.com/whatMBSR.php. Mindful Living Programs Web site. Accessed August 12, 2010.
45. Grossman P, Neimann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004;57(1):35-43.
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.