Professional Documents
Culture Documents
Examen Cele I
Examen Cele I
Examen Cele I
Many serious threats to humanity's future (from climate change and ozone
depletion to air pollution and toxic contamination) arise largely from the
economy's failure to value and account for environmental damage. Because those
causing the harm do not pay the full costs, unsuspecting portions of society end up
bearing them (often in unanticipated ways). People in the United States, for
example, annually incur tens of billions of dollars in damages from unhealthy levels
of air pollution, but car drivers pay nothing at the gas pump for their part in this
assault. Similarly, if farmers pay nothing for using nearby waterways to carry off
pesticide residues, they will use more of these chemicals than society would want,
and rural people will pay the price in contaminated drinking water.
Opinion polls show that a good share of the public thinks more should be spent on
protecting the environment, but most people abhor the idea of higher taxes. By
shifting the tax base away from income and toward environmentally damaging
activities, governments can reflect new priorities without increasing taxes overall.
So far, most governments trying to correct the market's failures have turned to
regulations, dictating specifically what measures must be taken to meet
environmental goals. This approach has improved the environment in many cases,
and is especially important where there is little room for error, such as in disposing
of high-level radioactive waste or safeguarding an endangered species. Taxes would
be a complement to regulations, not a substitute.
Environmental taxes are appealing because they can help meet many goals
efficiently. Each individual producer or consumer decides how to adjust to the
higher costs. A tax on air emissions, for instance, would lead some factories to add
pollution controls, others to change their production processes, and still others to
redesign products so as to generate less waste. In contrast to regulations,
environmental taxes preserve the strengths of the market. Indeed, they are what
economists call corrective taxes: they actually improve the functioning of the
market by adjusting prices to better reflect an activity's true cost.
There are, however, some notable exceptions. In the United Kingdom, a higher tax
on leaded gasoline increased the market share of unleaded petrol from 4 percent in
April 1989 to 30 percent in March 1990. And in late 1989, the U.S. Congress
passed a tax on the sale of ozone-depleting chlorofluorocarbons (CFCs) in order,
to hasten their phaseout, which the nation has agreed to do by the end of the
decade, and to capture the expected windfall profits as the chemicals' prices rise.
The most widely used CFCs are initially being taxed at $3.02 per kilogram ($ 1.37
per pound), roughly twice the current price; the tax will rise to $6.83 per kilogram
by 1995 and to $10.80 per kilogram by 1999. During the first five years, this is
expected to generate $4.3 billion, which multiple effects (a carbon tax for example,
would lower both carbon and sulfur dioxide emissions by discouraging fossil fuel
consumption) and because the taxed activities will decline even before taxes are
fully in place, revenues shown in the table cannot be neatly totaled. But it seems
likely that the eight levies listed here could raise on the order of $ I30 billion per
year, allowing personal income taxes to be reduced about 30 percent.
B. la utilización de sus economías como un poderoso instrumento para corregir las deficiencias.
C. la utilización, por ejemplo, de la luz solar en vez de carbón para generar electricidad.
B. la gente piensa que debe gastarse más para proteger el medio ambiente.
C. una minoría piensa que no deben aumentarse los impuestos para proteger el medio ambiente.
C. los fracasos del mercado económico han llevado a leyes más estrictas.
C. los 50 impuestos ecológicos que existen en muchos países se han establecido entre 14 de sus
miembros.
dólares.
C. propuso impuestos que a la larga modificarían los patrones de consumo de la ex Alemania
Oriental.
B. se requeriría el aumento del impuesto en 200% para reducir a la mitad el uso de éstos.
1.
A. designed
B. defined
C. imagined
2.
A. pregnancy
B. disorder
C. condition
3.
A. partner
B. person
C. couple
4.
A. nicely
B. sufficiently
C. privately
5.
A. ideal
B. immature
C. surrogate
6.
A. strong
B. fertile
C. barren
7.
A. aborted
B. produced
C. lost
8.
A. carries
B. helps
C. favors
9.
A. conceals
B. assumes
C. requires
10.
A. contract
B. business
C. deposit
11.
A. to bear
B. to change
C. to hold
12.
A. childhood
B. motherhood
C. relative
13.
A. arrangements
B. outlines
C. investments
14.
A. decided
B. knew
C. estimated
15.
A. definitely
B. ultimately
C. approximately
16.
A. different
B. odd
C. total
17.
A. raises
B. sanctions
C. classifies
18.
A. financial
B. irrational
C. legal
19.
A. obligation
B. necessity
C. nature
20.
A. complications
B. principles
C. categories
21.
A. acceptability
B. improbability
C. reality
22.
A. concern
B. freedom
C. maturity
23.
A. real
B. available
C. potential
24.
A. near
B. friendly
C. related
25.
A. issue
B. option
C. decision
26.
A. viewing
B. rejecting
C. lacking
27.
A. underestimates
B. estimates
C. rejects
28.
A. loving
B. distinct
C. visionary
29.
A. ordered
B. permanent
C. clean
30.
A. unrelated
B. genetic
C. creative
31.
A. situation
B. problem
C. present
32.
A. probability
B. instability
C. stability
33.
A. parents
B. children
C. issues
Costs and causes of executive alcoholism, drug abuse and
mental illness
How much are troubled senior executives costing their organizations? No one
knows for sure. Although the costs of mental illness in the population as a whole
and in the hourly employee work force in particular are generally well documented,
data about the costs of troubled senior executives are not available. Many
corporations do not keep separate records about the nature or cost to the firm of
their impaired senior executives, preferring to merge these data with those for
overall employee impairment. As a consequence, it is difficult to be precise in
determining the costs of senior executive alcoholism, drug abuse, or mental illness
within an organization. In addition, many of the costs of senior executive
impairment are not quantifiable and, therefore, cannot be subjected to rigorous
analysis.
Although difficult to measure, the costs of troubled senior executives fall into
several categories. First is the cost of lost productivity, that is, paying substantial
salary and benefits to a troubled senior executive who is not performing. An
executive whose yearly salary is $400,000 and who receives an additional $100,000
a year in benefits but who works at only one fifth of his or her maximum
productive effort loses the firm more than $7,000 a week a good deal more than
the cost of the most expensive psychiatric treatment.
The second category of costs includes sick leave, absenteeism, health care costs,
and disability payments. Troubled senior executives may be absent from the office
for significant periods of time due to illness. If their illness has progressed to the
point of no return, they may become permanently disabled and need to
prematurely retire. Troubled senior executives may run up large health care bills,
for example, for repeated hospitalizations for alcoholic cirrhosis of the liver,
repeated psychiatric hospitalizations for recurrent depressive or psychotic
episodes, and the like.
Termination and replacement costs make up the third category. The cost of
replacing senior executives who must eventually be released can be quite high
when the costs of recruitment, hiring, orientation, and training are included.
The fourth category includes the costs of poor professional judgment and bad
business decisions. As noted earlier, troubled senior executives often display poor
business judgment and make bad decisions that may adversely affect the firm as a
whole. The more senior the executive, the greater the impact of the bad decision.
The fifth category includes the costs of lowered morale, negative publicity, and
damage to the corporate image if the inappropriate actions and behaviors of
troubled senior executives become public knowledge or widely known in the
corporate community. Alcoholic executives embezzling corporate funds, manic
executives getting involved in messy extramarital affairs, drug-dependent executives
selling inside information to support their habit, depressed executives committing
suicide, psychotic executives attacking other executives or employees all are
examples that fall within this fifth category.
Last of all are the cots of litigation when the organization has to defend itself
against legal action taken by the terminated executive for wrongful discharge or
discrimination. Legal action can also be initiated by other executives who may have
been emotionally abused or physically harmed by the troubled executive.
Alcoholism and drug abuse and dependency are psychiatric disorders in their own
right (Vailant, 1983; Mirin, 1984). The causes of alcoholism in executives and other
individuals are still not clearly understood. One popular theory is that the causation
of alcoholism is a function of genetic endowment. Family studies clearly show that
relatives of alcoholics have a higher rate of alcoholism than the population as a
whole (Kaplan and Sadock, 1985). Adoption studies conducted in Denmark
concluded that adopted males whose biological parents were alcoholics were more
than four times as likely to become alcoholics as adopted males whose parents
were not alcoholics (Kaplan and Sadock, 1985). They usually developed severe
cases of alcoholism by their early twenties and usually required treatment. Another
theory of etiology is that alcoholism is a function of early childhood experience and
family dynamics. Investigators have discovered that family histories of alcoholics
often reveal childhood environments of marital and family conflict and parental
emotional neglect. The child of an alcoholic is unable to get his or her emotional
needs fulfilled and experiences feelings of anger, depression, and guilt.
A third category of causation is that alcohol acts as a direct toxin on the brain,
destroying vital brain tissue and significantly altering brain function. This results in
the appearance of a variety of other psychiatric illnesses, including several of the
organic mental disorders. There also appears to be a strong relationship between
depression and the extended use of drugs or alcohol. Individuals who were
depressed prior to drug or alcohol abuse frequently turn to drugs or alcohol as a
way to ease their emotional pain. Unfortunately, continued use usually results in
greater levels of depression rather than less because of the toxic effect of the
substances on the brain. The deepening depression in turn results in continued
alcohol or drug use, and the vicious cycle continues.
What about the causes of drug abuse? Because there are so many different types of
drugs to abuse and become dependent on, it is difficult to postulate one
comprehensive theory of causation of drug abuse and dependency (Vaillant,1983;
Mirin, 1984). Also, as with alcohol, there is little agreement within the psychiatric
community as to the definitive origins of drug abuse and dependency. Research
data suggest that drug abuse and dependency are a disease caused by complex
interaction of biological vulnerabilities, psychological issues, and environmental
settings. Drug abusers usually have a history of experimentation with more socially
approved substances like tobacco, alcohol, and marijuana (Kaplan and Sadock,
1985). Recent studies also indicate that drug abusers have problems with poor
impulse control, ego deficits, and an inability to appropriately manage intense
affects, including anger and rage (Kaplan and Sadock,1985). It is thought that some
of these deficits in psychological structures and their associated functioning are in
part a consequence rather than a cause of long-term chronic drug use. Becoming a
drug abuser appears to be a function of the following: the cost, availability, and
status of the drug; the financial condition of the drug abuser; the methods of
initiation and the social supports that encourage continued usage; the psychological
makeup and biological vulnerabilities of the individual; the type and intensity of
current life stressors; the coping skills of the drug abuser; and the unwitting
encouragement of the social or occupational environment. Drug abusers often have
a low frustration tolerance and a need for immediate gratification. They are
motivated to seek to induce and perpetuate a highly pleasurable mental state.
Recent research indicates that certain drugs may impact on the genetically
vulnerable brain to produce biochemical changes that further induce the drug-
seeking and drug-taking behavior (Kaplan and Sadock, 1985).
2. Hay registros muy completos sobre el costo que ocasionan a las empresas
los ejecutivos de alto rango que sufren de problemas mentales.
o V
o F
11. Una teoría sobre el alcoholismo indica que el alcohol actúa como una toxina
para el cerebro y es la causa de problemas mentales orgánicos.
o V
o F
14. Estudios recientes afirman que la falta de habilidad para manejar emociones
como la ira puede ser consecuencia del abuso crónico de las drogas.
o V
o F
15. Entre los factores que pueden dar origen a un drogadicto se encuentra la
manera en que una persona se enfrenta a los problemas diarios.
o V
o F
18. Los trastornos psicológicos sólo son causados por problemas que afectan a
los individuos en particular, no a la empresa en general.
o V
o F
Why do some people earn more than others? And what can be done to enhance
an individual's or a group's productivity and earning power?
Such findings have many implications. They _____29_______ , for example, that a
subtle effect of rising _____30_______ inequality may be to erode the self-esteem
and productivity of those who feel they have fallen behind. More significantly, since
much of self-esteem is acquired in childhood, the results underscore the
importance of parents and teachers acting to enhance this aspect of "psychological
capital" in addition to fostering youngsters' acquisition of basic skills.
1.
A. suits
B. questions
C. efforts
2.
A. including
B. reducing
C. investing
3.
A. force
B. load
C. experience
4.
A. issue
B. surplus
C. system
5.
A. Care
B. Family
C. Labor
6.
A. expression
B. variable
C. stability
7.
A. intends
B. adopts
C. knows
8.
A. method
B. personality
C. opposition
9.
A. economists
B. workers
C. solicitors
10.
A. style
B. impact
C. devise
11.
A. exploit
B. measure
C. bend
12.
A. problem
B. achievement
C. research
13.
A. analogy
B. hardship
C. survey
14.
A. cheap
B. accepted
C. amazing
15.
A. results
B. conditions
C. qualifications
16.
A. code
B. capital
C. view
17.
A. smooth
B. small
C. big
18.
A. analysis
B. topic
C. policy
19.
A. stregth
B. attitude
C. effect
20.
A. gathered
B. acquainted
C. correlated
21.
A. modernity
B. causality
C. regularity
22.
A. esteem
B. control
C. care
23.
A. pretended
B. treated
C. tended
24.
A. sensibility
B. productivity
C. responsibility
25.
A. flexible
B. sensitive
C. firm
26.
A. distributions
B. changes
C. distinctions
27.
A. claim
B. rise
C. decrease
28.
A. improvement
B. research
C. education
29.
A. stimulate
B. suggest
C. deny
30.
A. income
B. loans
C. expense
Who killed the newspaper?
The most useful bit of the media is disappearing. A cause for concern,
but not for panic.
"A GOOD newspaper, I suppose, is a nation talking to itself," mused Arthur Miller
in 1961. A decade later, two reporters from the Washington Post wrote a series of
articles that brought down President Nixon and the status of print journalism
soared. At their best, newspapers hold governments and companies to account.
They usually set the news agenda for the rest of the media. But in the rich world
newspapers are now an endangered species. The business of selling words to
readers and selling readers to advertisers, which has sustained their role in society,
is falling apart.
Of all the "old" media, newspapers have the most to lose from the internet.
Circulation has been falling in America, Western Europe, Latin America, Australia
and New Zealand for decades (elsewhere, sales are rising). But in the past few
years the web has hastened the decline. In his book "The Vanishing Newspaper",
Philip Meyer calculates that the first quarter of 2043 will be the moment when
newsprint dies in America as the last exhausted reader tosses aside the last
crumpled edition. That sort of extrapolation would have produced a harrumph
from a Beaverbrook or a Hearst, but even the most cynical news baron could not
dismiss the way that ever more young people are getting their news online. Britons
aged between 15 and 24 say they spend almost 30% less time reading national
newspapers once they start using the web.
Advertising is following readers out of the door. The rush is almost unseemly,
largely because the internet is a seductive medium that supposedly matches buyers
with sellers and proves to advertisers that their money is well spent. Classified ads,
in particular, are quickly shifting online. Rupert Murdoch, the Beaverbrook of our
age, once described them as the industry's rivers of gold, but, as he said last year,
"Sometimes rivers dry up." In Switzerland and the Netherlands newspapers have
lost half their classified advertising to the internet.
Newspapers have not yet started to shut down in large numbers, but it is only a
matter of time. Over the next few decades half the rich world's general papers may
fold. Jobs are already disappearing. According to the Newspaper Association of
America, the number of people employed in the industry fell by 18% between 1990
and 2004. Tumbling shares of listed newspaper firms have prompted fury from
investors. In 2005, a group of shareholders in Knight Ridder, the owner of several
big American dailies, got the firm to sell its papers and thus end a 114-year history.
This year Morgan Stanley, an investment bank, attacked the New York Times
Company, the most august journalistic institution of all, because its share price had
fallen by nearly half in four years.
Having ignored reality for years, newspapers are at last doing something. In order
to cut costs, they are already spending less on journalism. Many are also trying to
attract younger readers by shifting the mix of their stories towards entertainment,
lifestyle and subjects that may seem more relevant to people's daily lives than
international affairs and politics are. They are trying to create new businesses on
and offline. And they are investing in free daily papers, which do not use up any of
their meagre editorial resources on uncovering political corruption or corporate
fraud. So far, this fit of activity looks unlikely to save many of them. Even if it does,
it bodes ill for the public role of the Fourth Estate.
In the future, as newspapers fade and change, will politicians therefore burgle their
opponents' offices with impunity, and corporate villains whoop as they trample
over their victims? Journalism schools and think-tanks, especially in America, are
worried about the effect of a crumbling Fourth Estate. Are today's news
organisations "up to the task of sustaining the informed citizenry on which
democracy depends?" asked a recent report about newspapers from the Carnegie
Corporation of New York, a charitable research foundation.
Nobody should relish the demise of once-great titles. But the decline of
newspapers will not be as harmful to society as some fear. Democracy, remember,
has already survived the huge television-led decline in circulation since the 1950s. It
has survived as readers have shunned papers and papers have shunned what was in
stuffier times thought of as serious news. And it will surely survive the decline to
come.
That is partly because a few titles that invest in the kind of investigative stories
which often benefit society the most are in a good position to survive, as long as
their owners do a competent job of adjusting to changing circumstances.
Publications like the New York Times and the Wall Street Journal should be able to
put up the price of their journalism to compensate for advertising revenues lost to
the internet, especially as they cater to a more global readership. As with many
industries, it is those in the middle, neither highbrow, nor entertainingly populist,
that are likeliest to fall by the wayside.
The usefulness of the press goes much wider than investigating abuses or even
spreading general news; it lies in holding governments to account-trying them in
the court of public opinion. The internet has expanded this court. Anyone looking
for information has never been better equipped. People no longer have to trust a
handful of national papers or, worse, their local city paper. News-aggregation sites
such as Google News draw together sources from around the world. The website
of Britain's Guardian now has nearly half as many readers in America as it does at
home.
In addition, a new force of "citizen" journalists and bloggers is itching to hold
politicians to account. The web has opened the closed world of professional
editors and reporters to anyone with a keyboard and an internet connection.
Several companies have been chastened by amateur postings of flames erupting
from Dell's laptops or of cable TV repairmen asleep on the sofa. Each blogger is
capable of bias and slander, but, taken as a group, bloggers offer the searcher after
truth boundless material to chew over. Of course, the internet panders to closed
minds; but so has much of the press.
In the future, argues Carnegie, some high-quality journalism will also be backed by
non-profit organisations. Already, a few respected news organisations sustain
themselves that way, including the Guardian , the Christian Science
Monitor and National Public Radio. An elite group of serious newspapers available
everywhere online, independent journalism backed by charities, thousands of fired-
up bloggers and well informed citizen journalists: there is every sign that Arthur
Miller's national conversation will be louder than ever.
B. eficiente.
C. sencillo.
8. Según el texto, una de las ventajas del uso de Internet para el público es que
A. ahora es más fácil comunicarse con el gobierno.
9. En el contexto del párrafo 10, el significado más cercano a "is itching to" es
A. ansioso de empezar algo.
B. reacio a hacer algo.
B. negativo
C. positivo
The speech –astonishing not so much for what it said as for who said it- may go
down in history as the day that the stodgy newspaper business officially woke up to
the new realities of the internet age. Talking at times more like a pony-tailed,
newage technophile than a septuagenarian old-media god-like figure, Mr. Murdoch
said that news "providers" such as his own organization had better get web-savvy,
stop lecturing their audiences, "become places for conversation" and "destinations"
where "bloggers" and "podcasters" congregate to "engage our reporters and
editors in more extended discussions."
Mr. Murdoch's argument begins with the fact that newspapers worldwide have
been -and seem destined to keep on- losing readers, and with them advertising
revenue. In 1995-2003, says the World Association of Newspapers, circulation fell
by 5% in America, 3% in Europe and 2% in Japan. In the 1960's, four out of five
Americans read a paper every day; today only half do so. Philip Meyer, author of
"The Vanishing Newspaper: Saving Journalism in the Information Age", says that if
the trend continues, the last newspaper reader will recycle his final paper copy in
April 2040.
Gotcha!
The decline of newspapers predates the internet. But the second –broadband-
generation of the internet is not only accelerating it but is also changing the
business in a way that previous rivals to newspapers –radio and TV- never did.
Older people, whom Mr. Murdoch calls "digital immigrants", may not have noticed,
but young "digital natives" increasingly get their news from web portals such as
Yahoo! or Google, and from newer web media such as blogs. Short for "web logs",
these are online journal entries of thoughts and web links that anybody can post.
Whereas 56% of Americans have heard of blogs, and only 3% read them daily,
among the young they are standard fare, with 44% of online Americans aged 18-29
reading them often, according to a poll by CNN/USA Today/ Gallup.
Blogs, moreover, are but one item on a growing list of new media tools that the
internet makes available. Wikis are collaborative web pages that allow readers to
edit and to contribute. This, to digital immigrants, may sound like a recipe for
anarchic chaos, until they visit, for instance, wikipedia.org, an online encyclopedia
that is growing dramatically richer by the day through exactly this spontaneous
(and surprisingly orderly) collaboration among strangers. Photoblogs are becoming
common; videoblogs are just starting. Podcasting (a conjunction of iPod, Apple's
iconic audio player, and broadcasting) lets both professionals and amateurs produce
audio files that people can download and listen to.
It is tempting, but wrong, for the traditional mainstream media to belittle this sort
of thing. It is true, for instance, that the vast majority of blogs are not worth
reading and, in fact, are not read (although the same is true of much in traditional
newspapers). On the other hand, bloggers play an increasingly prominent part in
the wider media drama. The most popular bloggers now get as much traffic
individually as the opinion pages of most newspapers. Many bloggers
are windbags, but some are world experts in their fields. Matthew Hindman, a
political scientist at Arizona State University, found that the top bloggers are more
likely than top newspaper columnists to have gone to a top university, and to have
an advanced degree, such as a doctorate.
"The basic notion is that if people have the tools to create their own content, they
will do that, and that this will result in an emerging global conversation," says Dan
Gillmor, founder of Grassroots Media in San Francisco, and the author of "We the
Media" (O'Reilly, 2004), a book about, well, grassroots journalism.
With so many new kinds of journalists joining the old kinds, it is also likely that new
business models will arise to challenge existing ones. Some bloggers are allowing
Google to place advertising links next to their posting, and thus get paid every time
a reader of their blog clicks on them. Other bloggers, just like current providers of
specialist content, may ask for subscriptions to all, or part, of their content. Tip-jar
systems, where readers click to make small payments to their favorite writers, are
catching on.
The tone in these new media is radically different. For today's digital natives, says
Mr. Gillmor, it is anathema to be lectured at. Instead, they expect to be informed
as part of an online dialogue. They are at once less likely to write a traditional
letter to the editor, and more likely to post a response on the web –and then to
carry on the discussion. A letters page pre-selected by an editor makes no sense to
them; spotting the best responses using the spontaneous voting systems of the
internet does.
Even if established media groups – such as Mr. Murdoch's- start to respond better
to these changes, can they profit from them? Mr. Murdoch says that some media
firms, at least, will be able to navigate the transition as advertising revenue switches
from print-based to electronic media. Indeed, this is one area where news
providers can use technology to their advantage, by providing more targeted
audiences for advertisers, both by interest group and location. He also thinks that
video clips, which his firm can conveniently provide, will be crucial ingredients of
online news.
But it remains uncertain what mix of advertising revenue, tips and subscriptions will
fund the news providers of the future, and how large a role today's providers will
have. What is clear is that the control of news –what constitutes it, how to
prioritize it and what is fact- is shifting subtly from being the sole purview of the
news provider to the audience itself. Newspapers, Mr. Murdoch implies, must learn
to understand their role as providers of news independent of the old medium of
distribution, the paper.
C. indiferente
D. negativa
2. Con base en el segundo párrafo podemos decir que el Sr. Murdoch es:
A. una persona mayor en contra de la tecnología.
B. drásticamente
C. medianamente
D. imperceptiblemente
B. la televisión
C. los blogs
D. la radio
B. auditivos
C. enciclopédicos
D. participativos
B. positiva
C. sarcástica
D. humorística
B. mejor
C. la misma
D. menos
9. De acuerdo con el autor del texto, los blogeros pueden ser considerados
como:
A. corresponsales
B. parásitos
C. inofensivos
D. empresarios
10. ¿Cuál de los siguientes aspectos sería menos atractivo para los "digitales
nativos"?
A. diálogo en línea
B. carta al editor
C. votación electrónica
D. discusión en la red
11. ¿Cómo describirías las implicaciones para los medios tradicionales que se
mencionan en el penúltimo párrafo?
A. imperceptibles
B. improbables
C. positivas
D. negativas
The team approach is optimal for working with patients with diabetes. Assessing
the psychological and physiological effects of stress, stress management, and
biofeedback on blood glucose control are necessary. In addition to a physician with
special expertise in diabetes, the team consists of at least a certified biofeedback
practitioner, a certificate diabetes practitioner, a certified diabetes educator, and
the patient. The team works together in evaluating the effects of treatment on the
physiological and psychological aspects of glycemic control. Most biofeedback
practitioners do not have expertise in diabetes education and management.
However, when they treat patients with diabetes, they need to know the basic
physiology of diabetes and the fundamentals of diabetes management.
The psychologist practitioner carries out an initial interview with the diabetic to
determine stress -related physical and emotional symptoms. One assesses the
patient's perception of the effects of the stress on his or her blood glucose and his
or her perceived capabilities and management strategies. Psychological testing also
may be used to assess the person's level of depression, anxiety, anger, and current
stress.
The practitioner also conducts a psychophysiological assessment. Practitioners
differ on the specifics of this assessment but often monitor multiple modalities.
These often include muscle tension, skin conductance, and blood flow in the hands
(via skin temperature), heart rate, and breathing during the resisting baseline, and
during and after various standard office stressors. Our laboratory measures frontal
electromyography (EMG), heart rate, blood pressure, and finger temperature while
patients sit quietly with their eyes closed. The practitioner provides biofeedback,
relaxation therapies, and stress management. Relaxation and biofeedback can help
patients feel more in control of their physiology, psychological state, and their
illness. Furthermore, decreased plasma levels of stress hormones and sympathetic
activity mediate lowered arousal and diminished hyperglycemia.
The diabetes educator (and or physician) can interpret blood glucose values
because he or she understands the effects of hypoglycemic medications, diet, and
exercise on blood glucose. This person also obtains information about the person's
diabetes care regime.
History
With this information, one identifies the patient's knowledge, current self,
management, self - care deficits and problems, and capabilities to make appropriate
decisions and manage his or her disease. This information provides the basis for
instructing the patient about diabetes care and addressing problems with daily
management during later session
Starting at the time of diagnosis, patients with diabetes need to adjust their life-
style and behavior significantly. They must incorporate diabetes management
behavior into their daily routine. Psychological adjustment to IDDM and NIDDM
often is problematic. Therefore, counseling and supportive psychotherapy can be
useful during the early weeks and months after diagnosis. However, beginning a
biofeedback -assisted relaxation program may not be appropriate. Adding the clinic
appointment for biofeedback and home practice requirements necessary to learn
relaxation techniques might overload the resources of the patient. Furthermore, it
would be difficult to attribute improving in glycemic control to the biofeedback and
relaxation because the patient is starting multiple new behaviors concurrently.
Another reason for deferring biofeedback during the fist year after diagnosis is the
so -called diabetic "honeymoon period". This phenomenon is the partial or
complete remission of the signs and symptoms of diabetes soon after the onset of
IDDM when the pancreas temporarily produces insulin. The blood glucose level
may stabilize at close to normal, and the need for exogenous insulin may decrease
significantly or completely. This period may last one, several, or, rarely, 12 months
(Krall&Baser, 1989). One could mistakenly attribute a decrease need for
exogenous insulin to the biofeedback and stress management treatment instead of
to temporary pancreatic insulin production. When the honeymoon period ends
and the patient's beta cells are not longer capable of producing insulin, the patient
could misattribute the renewed need for exogenous insulin as a total failure of the
self-regulation process.
Patients must at least partially accept the idea that stress can negatively impact on
glycemic control. Increased average blood glucose, a wider range of values, an
increase in fasting blood glucose, and sometimes more frequent hypoglycemia are
common stress effects reported by patients. If a patient is unaware of or rejects the
correlation between stress and blood glucose, then perhaps stress is not affecting
that person's blood glucose. However, if he or she does not understand stress and
is unaware of the potential or its effects, the person may misunderstand its impact.
In this case, educate the patients about stress and its relationship to blood glucose.
This can improve the chance for treatment to help normalize blood glucose levels.
The goals of biofeedback-assisted are to:
There are no long term follow-up studies with diabetic population treated with
biofeedback or relaxation. However, we suggest periodic refresher sessions as is
common practice when treating other chronic disorders. The practitioner and the
patient determine the timing of the follow-up office sessions. One periodically
evaluates control described earlier.
B. valora los diferentes estados emocionales del paciente antes de proporcionar el medicamento
adecuado.
C. evalúa la percepción que tiene el paciente sobre los efectos de la tensión en su enfermedad.
C. se lleva a cabo con el paciente en estado basal durante varias e intensas sesiones.
4. El educador en diabetes
A. debe, dentro de sus funciones y en primer lugar, educar al paciente en todos los aspectos de
B. analiza la enfermedad en forma global en relación al paciente, indaga sobre sus conocimientos
C. debe recibir un curso que lo instruya sobre la enfermedad antes de poder evaluar los
B. porque este programa entraría en conflicto con la psicoterapia de apoyo que se aplica durante
"luna de miel".
C. puede enmascarar la producción de la insulina pancreática temporal del periodo "luna de miel".
C. dar los pasos necesarios para que el paciente adquiera la información necesaria.
B. la relación que existe entre las situaciones tensas y los niveles de glucosa.
antemano.
C. incrementar la habilidad del paciente para tratar de reducir su medición de glucosa en ayunas.
C. para diabéticos se practica por largos periodos puesto que la enfermedad es crónica.
1.
A. domineering
B. hereditary
C. characteristic
2.
A. Mixing
B. Melting
C. Growing
3.
A. behaviour
B. contribution
C. pattern
4.
A. equivalent
B. norm
C. basis
5.
A. evidence
B. technique
C. experience
6.
A. responses
B. characteristics
C. relationships
7.
A. studies
B. sequences
C. series
8.
A. avoid
B. repeat
C. produce
9.
A. flat
B. wrinkled
C. inconsistent
10.
A. round
B. harsh
C. distinct
11.
A. twins
B. sibilings
C. grandchildren
12.
A. hypothesis
B. system
C. sequence
13.
A. parents
B. children
C. relatives
14.
A. mixtures
B. figures
C. patterns
15.
A. avoid
B. persuade
C. provide
16.
A. for instance
B. in particular
C. for example
17.
A. vanishing
B. reappearance
C. fading
18.
A. election
B. probability
C. information
19.
A. present
B. connected
C. possible
20.
A. rejected
B. distinguished
C. expressed
21.
A. transmitted
B. combined
C. supported
22.
A. supply
B. inheritance
C. nature