SFSBM Review I Em Flashcards
Focusing exclusively on proximal causes of disease obscures the underlying determinants of health such as
natural selection, fetal and early childhood development, lifetime of environmental exposures and social interactions
3 ways that inherited genomes contribute to the risk of disease
- aneuploidy
- single-gene mutations
- multigene interactions of single nucleotide polymorphisms, whose expression is heavily influenced by developmental placticity and environmental factors
Natural selection has left us vulnerable to disease through a variety of mechanisms such as
- environmental mismatch
- selective pressure against post-reproductive maintenance/repair
- co-evolution with rapidly evolving pathogens
- heterozygote advantage
- design constraints
The dramatic drop in mortality from infectious disease over the last century largely predates
the introduction of clinical interventions such as immunizations and abs
Preventable premature morbidity and mortality throughout the world is most strongly linked to …
low socioeconomic status: poverty, illiteracy, poor living conditions, and social exclusion
social-ecological model
accounts for the full web-like complexity of health determinants on multiple levels: individual interpersonal organizational/institutional community policy
By any measure (wealth, income, education, neighborhood, occupation), the __________ of a population is a strong predictor of its health, and the relationship is continuous across all __________ (no threshold effect)
By any measure (wealth, income, education, neighborhood, occupation), the SOCIOECONOMIC STATUS of a population is a strong predictor of its health, and the relationship is continuous across all SES STRATA(no threshold effect)
intermediary factors between SES and health
Poor social capital, noxious environments, risky behaviors, and psychological stress (among other things)
Within SES strata, the _________ (rather than its absolute amount) becomes relevant
Within SES strata, the DISTRIBUTION OF WEALTH (rather than its absolute amount) becomes relevant
measures of inequities in income (e.g., ____ coefficient) are associated with a variety of social and health outcomes
measures of inequities in income (e.g., GINI coefficient) are associated with a variety of social and health outcomes
Gini coefficient
represents the fraction of the aggregate income in a population that would need to be redistributed to obtain full equality (roughly 48% in 2016).
stress response
the combined physiologic, cognitive, emotional and behavioral changes associated with a stressful exposure
This occurs when the challenges imposed by the physical or social environment exceed an individual’s emotional adaptive capacity, increasing the risk of a maladaptive stress response
Psychological stress
allostatic load
one model to explain how social determinants of health leave individuals more or less vulnerable to chronic disease over a lifetime
The most common clinical strategy for addressing stress
wait and intervene once the damage has occurred. This is done by diagnosing and treating stress-related disorders (e.g., depression, acute coronary syndrome, asthma) when they become symptomatic or their pathology is otherwise recognized.
advantage: does not require addressing the stress itself, which is time consuming and so does not lend itself to fast-paced, acute care settings.
___________ preventive interventions have the greatest impact on the health of societies, but ___________ interventions can be also be useful and have their advantages
POPULATION-BASED (LOW-RISK) preventative interventions have the greatest impact on the health of societies, but CLINICALLY-BASED (HIGH-RISK) interventions can be also be useful and have their advantages
Primary prevention
aims to eliminate precipitating causes of disease or injury before they occur
secondary prevention
targets existing pathology (or risks) that have yet to become symptomatic or cause harm
medical tx of cancer would be classified of which type of prevention?
tertiary
focus is on the patient’s future risk of harm rather than their present condition
Do most recipients of clinical preventive interventions personally benefit from them?
No.
this largely accounts for its relative inefficiency
unlike immunizations, the benefits and harms (which can be substantial) of ________ must be balanced for individual patients
unlike immunizations, the benefits and harms (which can be substantial) of CHEMOPREVENTIVE AGENTS must be balanced for individual patients
chemopreventative agents
pharmaceuticals or dietary supplements intended to protect against disease
many of these also used to treat previously diagnosed conditions, in which case they would not be considered chemopreventive (e.g. iron supplements to treat anemia, endocrine therapy to treat breast cancer)
Patient education is necessary but insufficient for behavior change; success depends on …
longitudinal sessions of patient-centered, motivational training performed in the context of the social ecologic model
Generally, __________ are associated with higher costs and potential harms compared to other preventive services
Generally, SCREENING PROGRAMS are associated with higher costs and potential harms compared to other preventive services
According tp USPSTF guidelines, clinicians should strongly consider the use of interventions receiving grade ____ recommendations and should consider not using grade ___ interventions
According tp USPSTF guidelines, clinicians should strongly consider the use of interventions receiving grade A AND B recommendations and should consider not using grade D interventions
Decision regarding grade C and I interventions must rely more heavily on factors other than research evidence, such as
scientific rationale, common sense, patient values, safety and cost
When using USPSTF guidelines it is still important to
stratify patients according to risk
modern biomedicine is based largely on the principle of
reductionism: the best (and some would say only) way to fully understand a complex system is to disaggregate it into its smaller component parts and study each individually
Proponents of holism argue that reductionism is inherently flawed because…
it fails to give adequate attention to the interactions between components and to the influence of irreducible phenomena
holism
alternative to reductionism
- what matters most is not the components themselves, but their relationship to one another
- holists may further argue that certain complex phenomena are irreducible, like the human mind
the most common indication is for non-allopathic therapies is for …
the management of pain
specific effects of therapies
presumed physiologic mechanism
non-specific effects of therapies
chance variation
natural history
concurrent tx
psychobiologic response
RCT’s are ill suited for the investigation of
most non-allopathic therapies (w/ exception of dietary supplements)
placebo response
an improvement in a patient’s (or research subject’s) illness attributable to the meaning (or prior conditioning) of an intervention rather than a presumed physiologic property of that intervention
in many ways, clinical placebo are synonymous with the context of care
The frequency and magnitude of effects routinely observed among controls in clinical trials are poorly predictive of _____ effects in clinical practice
The frequency and magnitude of effects routinely observed among controls in clinical trials are poorly predictive of PLACEBO effects in clinical practice
mechanisms underlying the placebo effect appear to primarily involve expectancy and conditioning (learned response)
expectancy and conditioning (learned response)
_______ is one of several TCM interventions based on pre-scientific concepts regarding the relationship between humanity and nature
acupuncture
Despite its vitalistic origins, ________ is now largely based on biomechanical principles
chiropractic
most chiropractors focus on conditions anatomically related to the spine; its long-standing popularity has had more to do with its high levels of patient satisfaction than clear evidence of efficacy
Implicit association research shows that _______ physicians commonly exhibit implicit bias against black patients
Implicit association research shows that NON-HISPANIC WHITE PHYSICIANS commonly exhibit implicit bias against black patients
