Health Full Flashcards
what is health according to the Anglo Saxons?
‘wholeness of body’
what are the 3 domains of health?
- Biological/Physical
- Psyhchological
- Social
describe the Biological/Physical domain of health
- having a ‘sound and disease free body’
- restore health by treating the ailing body
what are the limitations of the biological/physical domain of health?
- reductionist(only physical terms)
- only deals with illness instead of promoting health
- separates the mind and body
what is Cartesian Dualism
the idea that the mind and body are separate
describe the Psychological domain of health
- ‘general feeling of psychological wellbeing’
- cognition=ability to think clearly, reason and problem solve
- emotion=ability to think positively and maintain self-esteem
describe the Social domain of health
- ‘good level of social functioning’
- maintain strong social networks, maintain relationship and interpersonal skills
- factors include: socio-economic status, culture, education, ethnicity, gender
describe the Bio-Psycho-Social model of health
Biological, psychological and social domains of health interact with each other
what is the WHO definition of health?
‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’
what is a strength of the WHO definition of health?
acknowledges psychosocial factrs are important for health
what is a limitation of the WHO definition of health?
not everyone can be in a state of complete wellbeing for long periods of time
describe the Wellness Continuum of health
- most people are neither sick or healthy, they’re in-between
- acknowledges that a person’s health can improve or deteriorate
prehistoric period (10, 000 BC) description of health
- ill health caused by supernatural/magicio-religious reasons (invasion by evil spirits and sorcery)
- treatments:exorcism, use of portions/torture, trephination (drilling a hole in the skull to release evil spirits)
ancient Greeks concept of health
- rejected supernatural causes of disease
- identified role of bodily function in diseases
- humoral theory=diseases was caused by imbalance of bodily fluids
Greek god of health and medicine
- AESCULAPIUS
- carries a staff with twisted serpent representing rejuvenation/healing
AESCULAPIUS’ daughters that represent aspects of medicine
- Hygeia=Hygiene
- Panacea=universal remedy
- Iaso=recuperation
- Aglaea=healthy glow
- Aceso=healing
what is caused by an imbalance of phelgm? according to the Greeks
- PHLEGMATIC person (detached)=cold/headaches
- treatment=hot bath, warm food
what is caused by an imbalance of blood? according to the Greeks
- SANGUINE person (impulsive)=angina/epilepsy
- treatment=blood letting
what is caused by an imbalance of yellow bile? according to the Greeks
- CHOLERIC person (irritable)=jaundice
- treatment=blood letting/liquid diet
what is caused by an imbalance of black bile? according to the Greeks
- MELANCHOLIC person (serious)=hepatitis, ulcers
- treatment=hot bath
Middle ages definition of health
- punishment by God for misdeeds
- treatments=exorcism and prayer
- scientific scrutiny was prohibited
what was the definition of health during the Renaissance?
- mind/body dualism (Cartesian Dualism)
- physicians=guard body
- theologists=guard mind
- scientific enquiry re-emerges
what was the definition of health in the post renaissance?
- development of microscopy
- blood cells and muscle structure investigated
define health in the 19th century
- X-RAYS=see bodily organs
- cellular theory=disease is caused by damaged cells
- germ theory=identifying germs that cause diseases
- development of biological treatments
define health in the 20th century (biomedical model)
- separation of mind and body
- disease is caused by infected cells/hormone imbalance
- views people as biological machines
- treatment=fix the machine
success of the biomedical model
- major killers were communicable
- treatments=discovery of penicillin, vaccinations, better hygiene, nutrition and public health
how does the Bio-Psycho-Social model link to definition of health in the 20th century?
- 3 major killers= heart disease, cancer, vascular disease
- proven to directly link with psycho-social factors (smoking, stress, diet and exercise)
who uses health services and why?
- children (developing immune systems)
- elderly people (failing immune systems)
- women (pregnancy and childbirth)
- men (most likely to ignore symptoms)
how does attention affect the recognition of health?
- INTERNALLY FOCUSED people=focus on themselves so more likely to notice & report illness
- EXTERNALLY FOCUSED people=focus on environment so may not report illnesses
what are Sensitizers/monitors?
people who seek out information about their lillness
what are repressors/blunters?
people who avoid symptoms of bad health and health related information
what types of delay cause misuse of health services? (4 points)
- APPRAISAL delay
- ILLNESS delay
- UTILISATION delay
- SCHEDULING delay
what is APPRAISAL delay?
the time for individuals to decide they are ill
what is ILLNESS delay?
the time between recognising symptoms as illness and deciding to seek treatment
what is UTILISATION delay?
time between deciding to seek advice and actually seeking it
what is SCHEDULING delay?
time between making appointment and receiving treatment
what is a malingering?
- believing you are ill and remaining ill for secondary rewards
- form of overusing the health service
what are the reasons for malingering?
- emotional rewards:increased attention
- practical rewards:access to controlled medication/free from responsibility/financial gain
what emotional problems cause overusing of the heath service?
stress can cause high BP which is often mistaken for an illness
what factors help us to visit a practitioner?
- persistence of symptoms
- critical incident (sudden change in symptoms)
- treatment expectations (believing that the GP can make a difference
two types of consultations
- doctor centered
- patient centered
doctor centered consultation
- doctor is dominant->doctor makes decisions->patient is passive
- used in serious/terminal illnesses
- maximizes chances of being correct
patient centered consultation
- patient is active->joint decision between doctor and patient->doctor actively listens
- used in less serious illnesses
what factors can influence the success of a consultation?
-physical=appearance of the doctor, eye contact, tone of voice, gestures, gender, age
situational= items in the office, how busy the doctor appears to be
factors that affect making a successful diagnosis
- primacy effect-.importance placed on what physician heard first
- knowledge of the patient-frequency could mean a known malingerer
- self-report-absence of obvious signs, physician must rely on what patient said
effect of computers in health diagnosis
people may not seek medical advice for embarrassing symptoms
what is compliance?
- how well patient’s behaviour matches treatment plan set up BY DOCTOR
- DOCTOR CENTRED and patient is passive
what is adherence?
- how well the patient’s behaviour matches the treatment plan they AGREE with the doctor
- PATIENT CENTRED (joint effort)
what is concordance?
-RECIPROCAL ALLIANCE between patient and doctor
what affects medical non-adherence?
-severity of illness (60%of terminally ill patients don’t take medication due to fatalistic beliefs OR mild illnesses)
what are medical non-adherence behaviours?
- not taking pills
- skipping doses
- altering the medical plan
- not adhering to eating, drinking/resting guidelines
methods of measuring non-adherence? (6 points)
- self report (ask the patient)
- therapeutic outcome (patient getting better)
- doctor estimates their health
- pill and bottle counts
- electronic methods (data recorded in pill bottles)
- biochemical tests
limitation of self-report techniques to measure non-adherence
patients may not be truthful
limitation of ‘therapeutic outcome’ to measure non-adherence
even non-adherers get better
limitation of ‘doctors estimates’ as a measure of non-adherence
doctors may predict wrongly
have predicted non-adherence wrongly 41% of the time
limitation of ‘pill/bottle counts’ as a measure of non-adherence
pills may not have been consumed
limitation of ‘recording data in pill bottles’ as a measure of non-adherence
expensive
limitation of ‘biochemical tests’ as a measure of non-adherence
time consuming and confounding variables may affect results
three types of non-adherence
- UNWITTING:misunderstanding advice
- ERRATIC:forgetful or running out of medication
- RATIONAL:deliberate non-adherence
factors that affect RATIONAL NON-ADHERECE (7 POINTS)
- side effects
- cost of medication
- belief treatment isn’t working
- fear of dependence on treatment
- religious beliefs
- multiple physicians may reduce patient’s belief in the treatment
- unvoiced opinions
factors affecting ERRATIC NON-ADHERENCE (improving their memory)
- primacy effect may affect what is remembered
- patients may remember information better when there are pictograms (images)
- using simple and straightforward language
what are other factors that may affect non-adherence?
- depression: being de-motivated
- this may be improved by a good support system of friends and family
what are the implications of medical non-adherence?
- increase in healthcare costs
describe research into non-adherence in patients with foot-ulcers
- patients were told to elevate their feet, given antibiotics and special footwear
- patients didn’t adhere because FOOTWEAR WAS UNFASHIONABLE and FOOT-REST WAS BORING
- they knew of the outcomes of not adhering
why do we experience pain?
it is ‘adaptive’
provides us with feedback about bodily systems which leads us to seek treatment
two types of pain
ACUTE pain (less than 6 months) CHRONIC pain (more than 6 months)
what is acute pain?
- instant
- can be recurrent
- i.e migraines
what is chronic pain? (2types!)
- Chronic BENIGN pain=long term experienced to a similar intensity
- Chronic PROGRESSIVE pain=long term pain that worsens with time
ways of describing pain
- severity (mild, discomforting?)
- type (shooting, piercing?)
- pattern (continuous?)
how could we measure pain? (name of questionnaire and 4 domains)
McGill Pain Questionnaire:
- Sensory-how it feels
- Affective-how it affects emotionally
- Evaluative-pain intensity
- Miscellaneous
what is a disadvantage of the McGill Pain Questionnaire of measuring pain?
- designed by doctors so level of high level of literacy required
- time consuming
- open to biases (self-report)
name two examples of objective measures of pain in the lab
- COLD PRESSOR TASK: ‘can you feel the pain’
2. ALGOMETER: facial expressions/BP and HR measures
biological theories of pain
- Specificity Theory
- Pattern theory
what is the Specificity theory of pain (biological)
pain RECEPTORS in the skin detect pain related information via neurons and SENDS INFO to the brain
what is the pattern theory of pain (biological)
pain RECEPTORS send pain related information to the brain via NERVE IMPULSES but neural stimulation must reach a CRITCAL VALUE for pain sensations to occur
What are the limitations of biological theories of pain?
- doesn’t explain PAIN BUT NO RECEPTORS (Phantom Limb Syndrome)
- doesn’t explain RECEPTORS BUT NO PAIN (congenital analgesia; born with receptors but don’t feel pain)
What is neural plasticity?
receptors in one part of the brain are dormant so receptors in anther part try to compensate by creating sensations in the other part
what psychological factors affect detection of pain?
-LACK OF ATTENTION:
doesn’t perceive pain immediately; often in sport
-DISTRACTIONS
-PAIN MEANINGTHEY COULD GO HOME (occurred in soldiers)
-DEPRESSION resulted in higher pain perception
describe the Bio-Psycho-Social model of explaining pain (Gate Control Theory)
- Pain Gate exists in the SPINAL COLUMN which opens and closes to allow pain messages through
- NEGATIVE EMOTIONS=OPEN GATE MORE/POSITIVE EMOTIONS=CLOSE GATE MORE
What are some advantages of the Gate Control Theory explanation of pain?
- integrates psychological factors
- allows for variability of pain perception
- psychological interventions to treat pain; positive emotions=close gate
biological pain treatments
- drugs i.e morphine(negative=side effects; addiction)
2. biofeedback-tracking HR and BP then changing lifestyle
psychological treatments of pain
- hypnosis/relaxation
2. distration techniques
defining stress
- what causes stress (weather/financial worries)
2. the response we get from stress (anxiety/HR and BP)
classic model of stress: FIGHTOR FLIGHT
- activation of the Sympathetic Nervous System
- illicit physiological responses to deal with stress (HR)
classic model of stress: GENERAL ADAPTATION SYNDROME (GAS model)
-suggests people react similarly to stress
HOWEVER
-there are individual differences in responses to stress
Transactional Model of Stress
- idea that when a person is THREATENED and LACK RESOURCES to cope=stress
- explains why same stressors cause different responses
what is ‘habituation’ in stress?
coping with the same stressor when repeatedly presented
what is Psycho-Neuro-Immunology in stress?
the link between psychological factors (e.g. stress) and disease, via interactions between the nervous, endocrine and immune systems
describe stress response following the SAM Axis
- detect stressor
- negative emotional response
- Sympathetic Nerves
- Adrenal Medulla
- Excrete Adrenaline/Noradrenaline
(immediate)
describe stress response following the HPA Axis
- detect stressor
- Hypothalamus
- Pituitary gland
- adrenal cortex
- release cortisol
(takes longer than 20 mins)
why does the stress response become maladaptive
-modern stressors are financial/psychological and hardly stop
SO
-body continuously releases adrenaline/noradrenaline causing high blood pressure
methods of measuring stress (psychological)
- reports of negative and positive emotions
2. questionnaires
method of measuring stress (physiological)
- Adrenaline/Noradrenaline levels (HR, BP)
2. Cortisol levels (hair, saliva)
measuring the effects of NATURALISTIC stressors
- measuring cortisol levels and showing in a Diurnal Cortisol Pattern
- could result in CARDIOVASCULAR DISEASES, BUROUT, MEABOLIC SYNDROMES
measuring the effects of CONTROLLED LAB stressors
- public speaking
- Stroop task
- mental arithmetic
- noise manipulation
- mirror tracing tasks
what is a disadvantage of Controlled lab studies?
-not representative of real life stress
describe social support as a method of coping with stress
Philips 2006
-presence of a spouse/partner reduced BP in a lab based stress task (in women)
Lovell 2012
-support for caregivers improved psychological health
describe personality factors as a method of coping with stress
Kobasa 1979
‘Hardiness’ =more adaptive psycho-physiological responses to stress (high hardiness=less health complaints)
2. Type A personality=more health problems
Describe factors of Hardiness by Kobasa, 1979 as a way of dealing with stress
- Commitment=having a sense of purpose in life
- Control=belief that we can influence events in our life (high LOC)
- Challenge=perceiving stress as a challenge (opportunity for growth)
describe the Type A personality in relations to coping with stress
- usually hostile, angry, self-critical, intolerant
- associated with increased vulnerability to stress related diseases
- Friedmann and Rosenman, 1974, found type A personality had twice as many heart attacks
how do we link Type A personality to stress related diseases?
DIRECT MECHANISMS=high stress behaviours->activation of stress system=tough on cardiovascular system->CD
INDIRECT MECHANISMS=high stress behaviours->coping behaviours i.e. smoking->tough on cardiovascular system->CD
what are coping behaviours of stress?
- emotion focus (acute stress)=flight i.e. sleep, denial, distraction, substance use
- problem focused (chronic stress)=take action to deal with stress i.e. be proactive
- Animal Assisted Interaction is associated with improved cognition and immunity
describe virtual reality as a method of coping with stress
- high quality computer graphics and sounds to allow people face their stressors before going into the real world
- Advantages: time efficient, low cost, mobile, easy to use
- beneficial or children with autism, phobia, depressive patients
measuring obesity
BMI
-weight (kg) ÷ height (metres squared)
WEIGHT-HIP RATIO
-measures proportions of weight distribution around the torso
what are the BMI classifications of weight
less than 18.5=underweight 18.5-24.9=normal 25-29.9=overweight more than 30=obese more than 40=morbidly obese
what are some problems with BMI as a measure for obesity?
- doesn’t differentiate between weight of muscle and fat
- doesn’t factor in bone density, natural habit end exercise
biological explanations for obesity
- adipocytes (fat cells)
- basal metabolic rate
explain adipocytes as a biological explanation of obesity
- fat cells
- obese people have more, bigger adipocytes (due to genetics/childhood factors)
- energy input exceeds energy output=weight gain
explain BASAL METABOLIC RATE as a biological explanation of obesity
- levels of energy needed to sustain normal bodily functions
- low BMR=metabolise fewer calories
explain genetics as a biological explanation of obesity
- high concordance rates for obesity (64-84%) for identical twins reared together
- research showed BMI of a twin reared in location A could predict BMI of second twin
explain Set-Point Theory as a biological explanation of obesity
- ideal biological weight=a set point
- if weight departs from the ideal, body induces or decreases food cravings
- determinist
explain hormone dysfunction as a biological explanation of obesity
- as body fat increases, so does LEPTIN to suppress the feelings of hunger (satiation)
- OB(Gene)=rats with this gene didn’t produce enough leptin so body fat increases (cant stop eating)
explain socio-economic status as a psychological explanation of obesity
-lower SES=lower income, less education on diets/exercise, more stress = obesity
explain stress as a psychological explanation of obesity
stress increases eating behaviour
Zellner, 2006, stressed participants picked calorie dense foods
explain cultural factors as a psychological explanation of obesity
-more adverts for unhealthy foods =high obesity rates
implications of obesity
- being able to determine health by body type
- Pears=healthy=weight is at the bottom part of the body=fat is far from major organs
- Apples=weight stored at the top of the body=may lead to coronary diseases (fat is close to major organs)
implications of obesity
- being able to determine health by body type
- Pears=healthy=weight is at the bottom part of the body=fat is far from major organs
- Apples=weight stored at the top of the body=may lead to coronary diseases (fat is close to major organs)
what is substance misuse? (DSM-IV definition)
maladaptive pattern of substance use. leading to clinically significant impairment or distress:
- need more amounts t achieve desired effect
- withdrawal symptoms appear is not in use
- unsuccessful efforts to cut down
- reduce social/occupational activities
define substance misuse in short
a pattern of harmful use of any substance for mood-altering purposes
define substance misuse in short
a pattern of harmful use of any substance for mood-altering purposes
three categorises of substances
- stimulants
- depressants
- hallucinogens
what are stimulants
- stimulates/excites neural activity
- examples: caffeine, nicotine, cocaine
- activates fight/flight
what are depressants
- depresses/inhibits neural activity
- sedatives, hypnotics, tranquilizers
- changes in mood, cognition
- causes drowsiness,lethargy
what are hallucinogens?
- alter sensory perception and induce visual and auditory hallucinations
- cannabis, ecstasy, psychedelics
what are hallucinogens?
- alter sensory perception and induce visual and auditory hallucinations
- cannabis, ecstasy, psychedelics,
mechanisms of drugs
agonists=enhance actions of neurotransmitters
antagonists=inhibit actions of neurotransmitters
mechanisms of drugs
agonists=enhance actions of neurotransmitters
antagonists=inhibit actions of neurotransmitters
Bio-Psycho-Social model of addiction
-repeated consumption of a substance with physical and psychological dependence
biological model of addiction
BRAIN REWARD PATHWAY (part of limbic system)
- rewards evolutionarily advantageous behaviours i.e. eating, drinking
- releases of dopamine which elicits, pleasurable feelings and causes repitition
psychological model of addiction
-imitation=doing what is seen
-classical conditioning=learn to associate drinking with social occasions so grow up doing so
operant conditioning=rewards of using drugs i.e positive mood, which causes repetition of behaviour
biological model of addiction
BRAIN REWARD PATHWAY (part of limbic system)
-replaces and rewards the adaptive neural
psychological model of addiction
-imitation=doing what is seen
-classical conditioning=learn to associate drinking with social occasions so grow up doing so
operant conditioning=rewards of using drugs i.e positive mood, which causes repetition of behaviour
psychological treatments of addictions
CBT:reinforcement: rewards for not taking substance
ABSTINENCE: eliminating dependence on substance
biological treatments of addictions
medication: inhibiting dopamine release=inhibiting dopamine release
psychological treatments of addictions
CBT
-reinforcement: rewards for not taking substance
biologicaltreatments of addicitons
medication: inhibiting dopamine release=inhibiting dopamine release
relapse
more than 50% patients treated for alcohol addiction relapse within 3 months
