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Following eradication blood glucose 436 buy generic cozaar on-line, 2 World Health Organization reference laboratories were authorized to diabetes type 1 vs 2 purchase cozaar without prescription maintain stocks of variola virus diabetes test where to get cozaar 25 mg free shipping. In 2002 diabetes insipidus babies cozaar 25mg discount, the United States resumed immunization of military personnel deployed to certain areas of the world and initiated a civilian preevent smallpox immunization program in 2003 to facilitate preparedness and response to a smallpox bioterrorism event. Infected children may suffer from vomiting and seizures during this prodromal period. Most patients with smallpox tend to be severely ill and bedridden during the febrile prodrome. The prodromal period is followed by development of lesions on mucosa of the mouth or pharynx, which may not be noticed by the patient. This stage occurs less than 24 hours before onset of rash, which usually is the frst recognized manifestation of infectiousness. With onset of oral lesions, the patient becomes infectious and remains so until all skin crust lesions have separated. The rash typically begins on the face and rapidly progresses to involve the forearms, trunk, and legs, with the greatest concentration of lesions on the face and distal extremities. Lesions begin as macules that progress to papules, followed by frm vesicles and then deep-seated, hard pustules described as “pearls of pus. By the sixth or seventh day of rash, lesions may begin to umbilicate or become confuent. Lesions increase in size for approximately 8 to 10 days, after which they begin to crust. Once all the crusts have separated, 3 to 4 weeks after the onset of rash, the patient no longer is infectious. Variola minor strains cause a disease that is indistinguishable clinically from variola major, except that it causes less severe systemic symptoms, more rapid rash evolution, reduced scarring, and fewer fatalities. Generally, children with varicella do not have a febrile prodrome, but adults may have a brief, mild prodrome. Although the 2 diseases are confused easily in the frst few days of the rash, smallpox lesions develop into pustules that are frm and deeply embedded in the dermis, whereas varicella lesions develop into superfcial vesicles. Because varicella erupts in crops of lesions that evolve quickly, lesions on any one part of the body will be in different stages of evolution (papules, vesicles, and crusts), whereas all smallpox lesions on any one part of the body are in the same stage of development. The rash distribution of the 2 diseases differs; varicella most commonly affects the face and trunk, with relative sparing of the extremities, and lesions on the palms or soles are rare. Variola major in unimmunized people is associated with case-fatality rates of fi30% during epidemics of smallpox. The mortality rate is highest in children younger than 1 year of age and adults older than 30 years of age. In addition to the typical presentation of smallpox (90% of cases or greater), there are 2 uncommon forms of variola major: hemorrhagic (characterized either by a hemorrhagic diathesis prior to onset of the typical smallpox rash [early hemorrhagic smallpox] or by hemorrhage into skin lesions and disseminated intravascular coagulation [late hemorrhagic smallpox]) and malignant or fat type (in which the skin lesions do not progress to the pustular stage but remain fat and soft). Each variant occurs in approximately 5% of cases and is associated with a 95% to 100% mortality rate. Other members of this genus that can infect humans include monkeypox virus, cowpox virus, and vaccinia virus. In 2003, an outbreak of monkeypox linked to prairie dogs exposed to rodents imported from Ghana occurred in the United States. Cowpox virus was used by Benjamin Jesty in 1774 and by Edward Jenner in 1798 as material for the frst smallpox vaccine. Smallpox is spread most commonly in droplets from the oropharynx of infected people, although rare transmission from aerosol spread has been reported. Infection from direct contact with lesion material or indirectly via fomites, such as clothing and bedding, also has been reported. Because most patients with smallpox are extremely ill and bedridden, spread generally is limited to household contacts, hospital workers, and other health care professionals. Secondary household attack rates for smallpox were considerably lower than for measles and similar to or lower than rates for varicella. Diagnostic work-up includes exclusion of varicella-zoster virus or other common conditions that cause a vesicular/pustular rash illness. Cidofovir has been suggested as having a role in smallpox therapy, but data to support cidofovir use in smallpox are not available. Standard, contact, and airborne precautions should be implemented immediately, and hospital infection control personnel and the state (and/or local) health department should be alerted at once. Cases of febrile rash illness for which smallpox is considered in the differential diagnosis should be reported immediately to local or state health departments. Postexposure immunization (within 3–4 days of exposure) provides some protection against disease and signifcant protection against a fatal outcome. Except for severely immunocompromised people who are not expected to beneft from live vaccinia vaccine, any person with a signifcant exposure to a patient with proven smallpox during the infectious stage of illness requires immunization as soon after exposure as possible but within 4 days of frst exposure (“ring vaccination”). The vaccine does not contain variola virus but a 1 related virus called vaccinia virus, different from the cowpox virus initially used for immunization by Jesty and Jenner. Vaccinia vaccines are highly effective in preventing smallpox, with protection waning after 5 to 10 years following 1 dose; protection after reimmunization has lasted longer. However, substantial protection against death from smallpox persisted in the past for more than 30 years after immunization during infancy during a time of worldwide smallpox virus circulation and routine smallpox immunization practices. Smallpox vaccine had been recommended for adults participating in smallpox response team and for people working with orthopoxviruses. Information about vaccine administration and adverse events 2 can be found in the vaccine package insert and medication guide at Inoculation occurs at a site of minor trauma, causing a painless papule that enlarges slowly to become a nodular lesion that can develop a violaceous hue or can ulcerate. Secondary lesions follow the same evolution and develop along the lymphatic distribution proximal to the initial lesion. A localized cutaneous form of sporotrichosis, also called fxed cutaneous form, common in children, presents as a solitary crusted papule or papuloulcerative or nodular lesion in which lymphatic spread is not observed. A disseminated cutaneous form with multiple lesions is rare, usually occurring in immunocompromised children. Extracutaneous sporotrichosis is uncommon, with cases occurring primarily in immunocompromised patients. Pulmonary sporotrichosis clinically resembles tuberculosis and occurs after inhalation or aspiration of aerosolized spores. Disseminated disease generally occurs after hematogenous spread from primary skin or lung infection. Disseminated sporotrichosis can involve multiple foci (eg, eyes, pericardium, genitourinary tract, central nervous system) and occurs predominantly in immunocompromised patients. Notice to readers: newly licensed smallpox vaccine to replace old smallpox vaccine. The related species Sporothrix brasiliensis, Sporothrix globosa, and Sporothrix mexicana also cause human infection. The fungus is isolated from soil and plants, including hay, straw, thorny plants (especially roses), sphagnum moss, and decaying vegetation. Zoonotic spread from infected cats or scratches from digging animals, such as armadillos, has led to cutaneous disease. The incubation period is 7 to 30 days after cutaneous inoculation but can be as long as 3 months. Culture of Sporothrix species from a blood specimen suggests the disseminated form of infection associated with immunodefciency. Histopathologic examination of tissue may not be helpful, because the organism seldom is abundant. Special fungal stains to visualize the oval or cigar-shaped organism are required. Serologic testing and polymerase chain reaction assay show promise for accurate and specifc diagnosis but are available only in research laboratories. Itraconazole (6–10 mg/kg, up to a maximum of 400 mg, orally, daily) is the drug of choice for children with lymphocutaneous and localized cutaneous disease. The duration of therapy is 2 to 4 weeks after all lesions have resolved, usually for a total duration of 3 to 6 months. Alternative therapies include saturated solution of potassium iodide (1 drop, 3 times daily, increasing as tolerated to a maximum of 1 drop/kg of body weight or 40 to 50 drops, 3 times daily, whichever is lowest). Amphotericin B is recommended as the initial therapy for visceral or disseminated sporotrichosis in children. After clinical response to amphotericin B therapy is documented, itraconazole can be substituted and should be continued for at least 12 months.

This observation suggests the inhibitory activity of the plant extract in the peripheral conversion of T4 to diabetes foundation purchase generic cozaar online T3 diabetes symptoms foot purchase cozaar no prescription. Asian Journal of the herbal approach to diabetes test fĂĽr zuhause generic 50mg cozaar mastercard thyroid dysfunction is invariably necessary to diabetes type 1 nice guidelines discount cozaar 50mg with mastercard Pharmaceutical and Clinical Research Academic Sciences 2012;5(2):44-8. Protective role of Magnifera indica, Cucumis melo and Citrullus vulgaris peel extracts in chemically induced hypothyroidism. The combined effects of Trigonella and Allium extracts Review and Research 2013;23(2):203-11. Biologic variation is Journal of phytotherapy and phyto pharmacology 2003;10(8):665-8. Role of Moringa oleifera leaf extract in the regulation of Hill, Medical publishing division: 2005. Agnivesha, Charaka Samhita, Sutra Sthana, 21/4-10, refined and annoted of thyroid disease a review. Agnivesha, Charaka Samhita, Sutra Sthana, 21/10-16, refined and annoted by Charaka, redacted by Dridhabala with Ayurveda Deepika commentary by Chakrapanidatta; edited by Yadavji Trikamji Acharya; Varanasi: Chaukhamba Press; reprint 2011. Ethnobotanical studies on useful plants of Sirumalai Hills of Eastern Ghats, Dindigul District of Tamil Nadu, Southern India. Role of Fucus vesiculosus L extract in the regulation of thyroid hormones status in adult male rabbits Kerbala. Relative efficiency of three medicinal plants extract in the alternation of thyroid hormone concentrations in male mice. Tiwari R, Chakraborty S, Saminathan M, Dhama K, Singh S V, Ashwagandha (Withania somnifera). Role in Safeguarding Health, Immunomodulatory Effects, Combating Infections and Therapeutic Applications A Review. Therapeutic uses of Withania somnifera (ashwagandha) with a note on withanolides and its pharmacological actions. Asian Journal of Pharmaceutical and Clinical Research Academic Sciences 2011;4(1):1-4. Botanical insights into Autoimmune thyroid diseases, Integrative Practitioner, 2012, Professional solutions: 6. Bauhinia purpurea Linn A Review of its Ethnobotany, Phytochemical and Pharmacological Profile. Received February 16, 2017; Accepted May 16, 2017; Epub July 15, 2017; Published July 30, 2017 Abstract: Objective: the objective of the cross-sectional epidemiological study is to investigate the prevalence and the possible related lifestyle, metabolic risk factors of hypothyroidism in adults of Gansu province, Northwest China. Methods: Every participant was asked to complete a questionnaire, anthropometric measurements and venous blood samples. Keywords: Hypothyroidism, epidemiology, risk factor, protective factor Introduction risk factors such as sex, age, defcient iodine intake. A number of studies [8, 9] suggested Hypothyroidism is a common health problem in that lifestyle factors were associated with inthe world. Recentroidism was associated with an increased risk ly, several animal experiments reported that of cardiovascular disease [1], heart failure [2], lipotoxicity may have a contribution to the pacognitive and motor impairments [3], and nonthogenesis of thyroid dysfunction [10, 11]. The prevalence of hypothyroidism in lence of hypothyroidism in Gansu province, the general population is 4. The high prevalence of thyroidism in adults, and explored the related hypothyroidism maybe because of traditional risk factors of hypothyroidism. The informed consent was obtained, all particiworking range for this method is 0. A central certiHypothyroidism was defned as follows: 1) Subfed laboratory performed the hematological jects with T4<62. Educational Data analysis level was classifed into four groups: illiteracy, Data were recorded on the computer twice by primary school, secondary school, and undergraduate and above. Smoking habit was classitwo independent individuals who were responfed as currently or previously smoking and sible for logic and consistency checks. Frequency of seafood if in normal distribution and Mann-Whitney U intake was assessed in three groups: frequent test or Kruskal-Wallis H test if not in normal (fi3 times/week), occasional (<3 times/week), distribution. Results of non-nor10891 Int J Clin Exp Med 2017;10(7):10890-10897 Epidemiology of hypothyroidism in adults of Gansu Table 1. Results the prevalence of hypothyroidism in different the characteristics of study population by thygender and different age groups is shown in roid disease status are showed in Table 1. No Illiteracy Referent signifcant differences were found between the three groups on the Primary school 1. Hypothyroidism was found to be a common clinical <25 Referent problem affecting 10. Seafood intake: frequently: fi3 times/week), occasionally: <3 times/ week, and never. In males, the prevalence of In this study, we assessed the prevalence of hypothyroidism also increased with age. Our hypothyroidism in adults residing in Gansu study showed that the prevalence of hypothy10894 Int J Clin Exp Med 2017;10(7):10890-10897 Epidemiology of hypothyroidism in adults of Gansu roidism in female are signifcantly higher than group (4. Multivariate result, excessive iodine intake lead to hypothylogistic regression analysis proved that female roidism were also published [12, 13]. The proand increasing age were independent risk factective effects of seafood and salt intake on tors for hypothyroidism. Degenerative changes the development of hypothyroidism might be occurring in the thyroid of old people and comexplained by the increase of iodine intake. It had been found that autoimmution-based case-control study reported that nity played a dominant role in the occurrence moderate alcohol consumption had a protecof hypothyroidism [19, 20]. In a prospective study by Effraimidis In our study, we found that current or previous et al. However, in present study, we did not fnd a researches had focused on the association signifcant relationship between alcohol conbetween hypothyroidism and smoking habit sumption and hypothyroidism. Furthermore, we found that people who effect of smoking is decreased thyroid iodide had a family history of thyroid disease were not transport and organifcation in smokers protect signifcantly related with their development of against the development of autoantibodies [22, hypothyroidism. To fully illuminate the association between toms of hypothyroidism and low awareness for smoking and hypothyroidism, well-designed hypothyroidism result in the low diagnosis rate studies taking the amount and duration of may account for the phenomenon. The which may subsequently result in atheroscleroconsumption of seafood and salt are primary sis [28]. Although the implementation indicated that lipotoxicity seriously and extenof mandatory universal salt iodization has been sively harmed human health by promoting the successfully carried out in China from 1995, pathogenesis of metabolic diseases [29]. What’s more, in an animal damage and heart failure: an overlooked entistudy [31], long term high-fat lard feeding could ty. The strong point of this study is the large samInt J Endocrinol 2016; 2016: 5083746. Further, the study populaand prevention of clinical and subclinical hypotion belongs to different regions of Gansu provthyroidism. Secondly, urinary iodine in ies in the United States population (1988 to the study population was not measured. J Clin Endocrinol In conclusion, the prevalence of hypothyroidism Metab 2002; 87: 489-499. Stators and metabolic factor were associated with tus of thyroid function in Indian adults: two dethe occurrence and development of hypothycades after universal salt iodization. A proAlcohol consumption as a risk factor for autospective study with stronger study design immune thyroid disease: a prospective study. We acknowledge the support from Gansu [10] Zhao M, Tang X, Yang T, Zhang B, Guan Q, Shao Provincial Hospital, and researchers participatS, Xue F, Zhang X, Liu Z, Yuan Z, Song Y, Zhang ed in the study for data collection, the local H, Fang L, Yu C, Li Q, Zhang X, Gao L, Xu C and medical staff who contributed to the investigaZhao J. Lipotoxicity, a potential risk factor for tion and all participants enroll in this study. Analysis of the correlation between lipotoxicAddress correspondence to: Limin Tian, Departity and pituitary-thyroid axis hormone levels in ment of Endocrinology, Gansu Provincial Hospital, men and male rats. Tel: 86-931-8281582; E-mail: tlm6666@ [12] Shan Z, Chen L, Lian X, Liu C, Shi B, Shi L, Tong sina. References the iodine status and prevalence of thyroid disorders after introduction of mandatory uni[1] Ashizawa K, Imaizumi M, Usa T, Tominaga T, versal salt iodization for 16 years in China A Sera N, Hida A, Ejima E, Neriishi K, Soda M, cross-sectional study in 10 cities. Y, Li J, Chen Y, Zhao D, Shi X, Hu F, Mao J, Gu X, Clin Endocrinol (Oxf) 2010; 72: 689-695. Effect of 10896 Int J Clin Exp Med 2017;10(7):10890-10897 Epidemiology of hypothyroidism in adults of Gansu iodine intake on thyroid diseases in China. Smoking is negatively associated with the H, Tuhuti A, Abdunaimu M, Wang H, Jin X and presence of thyroglobulin autoantibody and to Xing S. Iodine nutrition status and thyroid disa lesser degree with thyroid peroxidase autoorders: a cross-sectional study from the Xinjiantibody in serum: a population study.

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In Kenya diabetes diet low income buy cheap cozaar 50 mg online, the project predominantly targets poor and marginalized pastoral communities in arid and semi-arid areas blood glucose nursing diagnosis proven cozaar 25 mg. In these communities diabetes mellitus type 2 mayo buy cheap cozaar 25 mg line, women often experience additional cultural barriers in accessing health services diabetic diet new zealand buy 50mg cozaar mastercard. The exception was in the provision of spectacles for reading, where the number of men was consistently higher. Some women perceived spectacles to be for reading only, and as most could not read, had minimal need for these. The demand for spectacles by women increased, possibly because women realized their use for seeing near objects and working with handicrafts. To explore the reasons for the lower uptake of cataract surgeries by women, focus group discussions were held with female health workers and benefciaries. These identifed cost and logistics of travel as major barriers to accessing services. Many women did not have access to family fnances to pay for surgery and travel costs. Women also had less access to information about treatments, due to lower literacy rates, and many saw cataracts as an inevitable consequence of ageing. Strategies were introduced to target women and make services in Khyber Pakhtunkhwa more gender-sensitive. Partnering hospitals have introduced gender-focused patient satisfaction surveys, and the number of female eye care workers will be increased. To strengthen the referral chain, more female health staff and paramedics will be trained to screen and refer women to hospitals, and female mid-level eye care staff will be trained in partnership with the Pakistan Government. Awareness and information about free cataract surgeries will be spread to better target female audiences including partnerships with women’s organisations and audio and video messages on media networks. Preliminary data shows encouraging trends and it is expected that these strategies will progressively increase the proportion of women accessing cataract services over the three years of the project. The output targets have been discussed with implementing partners and will be closely monitored. As outlined in Chapter 2, the costs of attending eye care services pose a signifcant barrier to access and can severely limit the well-being and life opportunities for individuals, and their families. First, priority services need to be expanded; secondly, more people need to be covered; and thirdly, out-of-pocket payments need to be reduced (1). In addressing these dimensions, countries need to make important choices including: which services should be covered frst; who should be prioritized; and how can out-of-pocket payments be shifted towards prepayment. For example, should interventions, such as the provision of spectacles, be prioritized over interventions needed for a smaller proportion of the population, such as trachomafi Should interventions for eye conditions that affect children be prioritized and included early on in the package, or should they be postponed for a later stage when more resources will be availablefi Classifcation of services into these three categories should be based on locally determined criteria, which may include cost-effectiveness, priority to those who are fnancially worse off (equity), and fnancial risk protection. When deciding on which services to expand, a useful starting point is, again, cost-effectiveness estimates, integrating these with concern for the fnancially worse off, and other criteria, such as safety, and health system capacity. The specifcation and balancing of these criteria need to be guided by robust public deliberation and participatory procedures. The eye care sector is well positioned to engage in an evidence-based dialogue given that many eye care interventions are highly costeffective and feasible to implement (10-13). When deciding on extending population coverage for a given set of services, low-income groups, rural populations, and other disadvantaged (in terms of services or health) groups should be prioritized. Health care is funded by a range of sources, including government budgets, social health insurance agencies, and households. While the median out-of-pocket spending on health represents less than 20% of 109 total health spending in high-income countries, it accounts for more than 40% in low-income countries (14). Out-of-pocket spending is a barrier to accessing health services, especially for those who are poor, and can be a substantial fnancial burden on those who use the services and their families. Out-of-pocket payments for health services push 100 million people into extreme poverty every year (14). To improve A package of eye access with fnancial risk protection, countries should therefore shift care interventions from out-of-pocket payments towards mandatory prepayments with is needed to pooling of funds. While this may be diffcult for some countries, facilitate the precedence should always be given to high-priority services and disadvantaged groups, including those who are poor. In the case of integration of eye insurance and other mandatory arrangements for prepayments, care into the countries should ensure that the inability to pay is not a barrier to health sector and 4 coverage. The repository is intended as a global resource to facilitate discussions at country level around what services to provide within health beneft packages. The repository will include information on a recommended package of eye care interventions (Box 5. The OneHealth Tool considers the demands on the health system, whether from a health-system-wide perspective or a programme-specifc perspective. It provides a single framework for planning, costing, impact analysis, budgeting and fnancing of strategies for all major diseases and health system components. The tool is prepopulated with defaults for disease prevalence and incidence; intervention protocols for promotive, preventive and curative care; and prices of drugs, supplies and equipment – all of which can be changed by the user. Outputs from an application can help planners answer the following questions: — What would be the health system resources needed to implement the strategic health planfi Since its release in 2012, the OneHealth Tool has been applied in more than 40 countries. The package will provide a set of evidenced-based and cost-effective interventions including the resource requirements for those interventions such as assistive products, equipment, medicines, consumables and workforce competencies. The process of developing the package starts with selecting a range of priority eye conditions based on global epidemiological data and proposals from experts in the feld. For example, if glaucoma is one of the conditions selected, working groups, comprising clinical and academic experts in the feld, will then identify evidence-based interventions for glaucoma by drawing on a range of sources including high-quality clinical practice guidelines and systematic reviews. Following this, a professional working group from each world region will engage in a three-step process towards developing a list of interventions for glaucoma. Once the list has been confrmed, working group members will agree on the appropriate service delivery platform for each intervention. Finally, the resources required for each intervention will be defned and the fnal package will undergo a thorough peer review process. For example, Cambodia has already established their priority eye care interventions within the context of their essential package of health services (Box 5. Since 2008, eye care has been routinely included as a priority in the Cambodian national health strategic plans. The planning process included projecting the estimated costs of activities and targets within the strategic plan, in order to inform priority setting and resource mobilisation. As part of this activity, costs associated with providing eye care services were estimated. This process required defning the resources, or inputs, associated with eye care, estimating the average cost for priority interventions, and projecting the total number of these priority interventions that needed to be provided each year, as well as the costs associated with running the overall programme, including activities such as monitoring and evaluation. This process enabled the MoH to assess the resources needed to meet national targets for eye care which informed the development of the national eye care plan (National Strategic Plan for Blindness Prevention and Control 2016–2020). The national plan includes comprehensive objectives that cover many aspects of strengthening health systems, such as workforce requirements. It also provides a high degree of detail, specifying activities, outputs, time frames, responsible agencies, targets, indicators and associated costs. In summary, the provision of good quality eye care, in accordance with population needs, reduces health inequalities; however, reliable information about population needs are essential. High-quality health systems in the sustainable development goals era: time for a revolution. Guidelines on Diabetic Eye Care: the International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings. The implementation of integrated peoplecentred eye care requires four strategies: 1. Creating an enabling environment this chapter provides high-level guidance on these four strategies for the eye care sector. It is acknowledged that countries may have different starting points when implementing these strategies, depending on the maturity of their health system, resources available, and local needs. Underserved and marginalized populations must be reached in order to guarantee universal access to quality services that are co-produced according to their specifc preferences and needs. In order to tailor these requirements to address eye care, countries must build targeted policy options and interventions.

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Ending It can be helpful to managing diabetes 7 day meal plan discount cozaar 50mg with amex spend a few minutes just lying quietly in a relaxed state diabetes mellitus doctor cozaar 25mg low cost. Finally diabetes in dogs urine test purchase generic cozaar line, count down silently and slowly: 5 4 3 2 1 0 blood sugar normal range chart cheap cozaar 25 mg with mastercard, and come out of the relaxation in your own time. Distraction Distraction is a good technique to fend off symptoms of anxiety and stress when they feel overwhelming. This can also give you space to deal with a situation in a more considered and positive manner. Distraction simply involves trying to take your mind off uncomfortable symptoms or thoughts. It is still important to remember that the symptoms of anxiety are not harmful or dangerous. Ideas to help distract you from your troubling thoughts or anxiety include: fi Try to appreciate small details in your surroundings. As with any relaxation exercise, it may take a few minutes before you begin to feel like it is working. Reducing avoidance People often get into the habit of avoiding situations that cause them difficulty. By avoiding situations we also stop ourselves from proving that we can cope in them. As a result our anxiety towards the situation continues and our confidence remains low. For instance, they may avoid going to work nights out, parties, restaurants, or taking part in a hobby. By avoiding all of these related situations, they never have a chance to practice in them or prove that they could cope well. If instead we confront difficult situations then it is possible to build up our confidence. List the things that you avoid Come up with a list of the situations that you often try to escape from or avoid. For example: Ranking these situations Rank your list of situations in order of difficulty. From the least anxiety provoking to the most anxiety provoking on a scale of 0 100. For example: Once you have done this, try to organise your items from least anxiety provoking to most anxiety provoking. Confronting the lowest ranked situation Try to confront the lowest ranked item on your list. You will likely find that although your anxiety might initially rise, it will drop if you remain in the situation for long enough. Moving on to the next lowest item When you feel comfortable with an item, try to move on to the next item on your list. Working through your list you will begin to feel anxious in fewer and fewer situations. You should find that tasks ranked as more difficult seem more manageable as you progress. You can continue to use the techniques you found helpful long into the future and they should continue to benefit you. If some of the ideas are not particularly helpful at first, it is perhaps worth sticking with them for a few weeks to give them a chance to work. Further Information and Resources For further information and self-help resources go to Moodjuice online. In the site you can explore various aspects of your life that may be causing you distress and obtain information that will allow you to help yourself. This includes details of organisations, services and other resources that can offer support. This self help guide comes from a series that you can access and print from Moodjuice. Other titles available include: fi Anger fi Anxiety fi Assertiveness fi Bereavement fi Chronic Pain fi Depression fi Obsessions and Compulsions fi Panic fi Phobias fi Post Traumatic Stress fi Sleep Problems fi Shyness and Social Phobia fi Stress. This study investigates the relationship between intolerance of uncertainty, worry, and statistics anxiety. Intolerance of uncertainty was significantly related to worry, and worry was significantly related to three types of statistics anxiety. Six types of statistics anxiety were significantly lower by the end of the semester. This is not new: Roberts and Bilderback (1980) noted as much when discussing student attitudes toward statistics. The authors pointed out that the fear students feel when finally forced to enroll is often detrimental to a successful experience in statistics classes. Other authors also acknowledge the problem of graduate students’ procrastination when it comes to enrolling in statistics classes. Statistics anxiety has been related to several variables, such as academic outcomes, attitudes, self-concepts, and personal characteristics such as the tendency to procrastinate. Statistics anxiety has also been shown to be detrimental to students in several ways, but cognitive processes related to this form of anxiety have apparently not been explored. Specifically, intolerance of uncertainty, and worry have each been related to generalized anxiety, and worry has been related to other forms of anxiety, but neither construct has yet been related to statistics anxiety. Statistics anxiety is believed to be a multi-dimensional construct, comprised of six types of anxiety: worth of statistics, interpretation anxiety, test and class anxiety, computation self-concept, fear of asking for help, and fear of statistics teachers (Cruise et al. Worth of statistics refers to students’ perception of the usefulness of statistics in everyday life. Interpretation anxiety refers to the anxiety felt when students are required to interpret statistical results or decide which type of analysis to use. Those who score high on this factor find statistical interpretation difficult and anxiety provoking. Test and class anxiety pertains to the general anxiety experienced by taking a statistics class. Students who score high on this factor feel anxiety when enrolling in a statistics course, attending statistics classes, or taking exams. Computation self-concept refers to anxiety experienced when computing statistical problems. Students who score high on this dimension doubt their ability, regardless of true ability, to solve statistical problems which may reflect their attitude toward the subject. Fear of asking for help reflects the Statistics Education Research Journal, 12(1), 48-59, iase-web. Students who score high on this factor experience higher levels of anxiety when approaching their instructor, or a classmate, for help understanding statistical problems or statistical descriptions in journal articles. The last factor, fear of statistics teachers, refers to the students’ perceptions of the statistics instructor. Those who score high on this dimension are more likely to perceive the instructor as being unable or unwilling to relate to the students as a human being, and to regard the instructor as someone to fear. Zeidner (1991) furthers the definition by adding that statistics anxiety is accompanied by worry, tension, and physiological symptoms of stress when students are faced with taking a statistics class. Similarly, Onwuegbuzie, Da Ros, and Ryan (1997), through a qualitative study, found that students affected by statistics anxiety experience symptoms ranging from mild discomfort to depression, panic, stress, headaches, sweating, emotionality, and other psychological and physical manifestations of anxiety. For example, students’ performance is often affected in both statistics and research classes (Chiesi & Primi, 2010; DeVaney, 2010; Keeley, Zayac, & Correia, 2008; Lalonde & Gardner, 1993; Murtonen & Lehtinen, 2003; Onwuegbuzie, 1997; Onwuegbuzie, 2000; Onwuegbuzie & Seaman, 1995; Perepiczka, Chandler, & Becerra, 2011; Zanakis & Valenza, 1997). In a sample of undergraduate psychology students, Lalonde and Gardner (1993) found that statistics anxiety had affected students’ attitude and motivation toward the subject, thereby affecting their learning. Similarly, Zanakis and Valenza (1997) explored the relationship between student grades and statistics anxiety in 166 students enrolled in business statistics courses. The authors found that students’ anxiety, though still high at course end, was reduced simply as a result of exposure and that this contributed to a reduction in interpretation anxiety. Further, the increase in perceived worth of statistics had the greatest influence on student achievement, with the increase contributing to higher grades.