Terms Test 1 Flashcards
Positive Renforcement
he process by which presentation of a stimulus (drug) increases the probability of a response (non dependent drug taking paradigms)
Negative Reenforcement
A process by which removal of an aversive stimulus (negative emotional state of drug withdrawal) increases the probability of a response (dependence-induced drug taking)
Cannabinoids
Most commonly used illicit drug
Medicinal uses: antiemetic, appetite stimulant, anticonsulsant, and analgesic.
Abuse potential: More people sought treatment for marijuana than any other illicit drug.
Acute effects: slowed cognitive processing, impaired short-term memory, inhibition, concentration, visual-spatial processing. May precipitate psychotic disorder. Associated w/ relapse of other addicitons.
Long term effects: 9% become addicted. After one month of abstinence “minimal effects on cognition”, endocrine effects
Stimulants (cocaine, methamphetamines)
Increase monomaines (DA, NE, and 5HT)
DA- acutely enhance, but chronically depletes
Acute effects on CNS: energy, alertness, decreased appetite, anxiety, paranoia, irritability, siezures, increased HR, BP, and TMP.
Sedatives/Hypnotics
Most people become dependent when treating an anxiety disorder of insomnia.
Severe withdrawal (up to 50% of people on benzos)
Symptom rebound (anxiety, insomnia, muscle tension) lasts up to 3 weeks after discontinuation is mostly a withdrawal syndrome
Symptom reemergence is not a withdrawal syndrome. Reoccurence of original sx. Can last months.
Alcohol
Wide variety of target proteins unlke drugs that are more specific.
Adults metabolize avg. of 1 oz per 3 hours.
Withdrawal sx:
0-36 hrs: seuzures (BAC doesn’t have to equal 0 to start), increased HR, BP, Temp,
Alcohol + Tobacco = synergistic effects on risks for cancer
Abuse is common, but often undetected by medical staff.
Opiods
Risk w/ nonmedical or perscription abuse
OD can cause death (respiratory suppression)
Anhedonia makes dependence hard to break.
Abuse
An intense desire to obtain increasing amounts of a particular drug to the exclusion of all other activities
Dependence
The body’s physical need (addiction) to a specific drug. Dependence may result in physical harm, behavior problems, and association with people who also abuse drugs. Stopping can result in withdrawal.
Tolerance
A state of progressively decreased responsiveness to a substance.
Takes more to get high.
Compulsive Use
- Drug is taken in larger amounts or for longer periods.
- Persistent desire to or unsuccessful attempts at controlling use of substance
- Development of a substance centered lifestyle
- Neglect of signficant personal or social interests or obligations.
Leading COD’s Age 1-24
- ) Unintentional Injuries (38%)
- ) Homicide (13%)
- ) Suicide (12%)
- ) Cancer (7%)
- ) Heart disease (3%)
Leading COD’s Ages 25-44
- )Unintentional injuries (25%)
- ) Cancer (14%)
- ) Heart Disease (12%)
- ) Suicide (11%)
- ) Homicide (6%)
Leading COD’s Agest 45-64
- ) Cancer (32%)
- ) Heart disease (21%)
- ) Unintentional injuries (7%)
- ) Chronic lower respiratory disease (4%)
- ) Chronic liver disease and cirrhosis (4%)
Leading COD’s Ages 65+
- ) Heart Disease (27%)
- ) Cancer (22%)
- ) Chronic lower respirator disease (7%)
- ) Stroke (6%)
- ) Alzheimer’s disease (5%)
WHO ranking of national health care systems
Five factors:
- ) Health level (life expectancy; 25% weight)
- ) Responsiveness (Speed, privacy protections, choice of care; 12.5% weight)
- ) Financial Fairness (25% weight)
- ) Health Distribution (how equally resources are shared; 25% weight)
- ) Responsiveness distribution (how equally responsiveness if distributed; 12.5% weight)
U.S. ranked 37th.
ACA key points
- ) Expanded medicaid and increased number of plans subsidized
- ) Created/Encouraged ACOs to coordinate care delivery for specified populations (pay based on outcomes)
- ) ACOs will contract with PCMHs to deliever and coordinate care acoss the spectrum of patient needs.
IHI Triple Aim
- ) Experience of Care
- ) Population health
- ) Per capita cost
Normative
Counting or measuring a behavior, event, etc. then defining the most common as normal
Reliability
Consistency of prediction over time, over predictors, over individuals and/or over assesment techniques.
AKA repeatability
Validity
AKA Accuracy
Degree of accuracy of predictive statements. Any statement can be valid or invalid (p=0 or p=1)
Diagnostic predictions are never wholly valid
Extinction
Whatever can be learned can be unlearned. Once reward/punishments change behaviors should fade.
Positive punishment
The presentation of an unfavorable event or outcome in order to weaken the response that follows.
I.e. parking ticket
Negative punishment
AKA punishment by removal
I.e. failing grade
Generalized reinforcer
Any reinforcer that acts across many different behaviors and people and culture.
Attention, affection, and approval.
Couvade syndrome
Male experiences similar pregnancy sx as wife
APGAR
Test performed twice at one minute and at five minutes.
Five clinical signs scored 0,1, or 2
One minute scores less than 4 = severe nervous system depression, immediate resuscitation
Five minute scores less than 7 place infant at risk for subsequent CNS dysfunction
Appearance Pulse Grimace Appearance Respiration
Edinburgh Post-natal Depression Scale
Test to assess mothers for post-natal depression.
Consists of ten statements relating of post-natal depression.
The social smile
Smiling may begin as early as two weeks.
At four months, peak smiling to unfamiliar face
5-6 months selective smiling to key persons (parents, sibs)
7-8 = stranger anxiety
Denver II
Scoring: Pass, fail, refusal, no opportunity to try.
Scored ITEMS as:
Advanced (completely right of normal)
Normal - Age line falls between 25th and 75th percentile
Caution - Child fails or refuses item when age line falls between the 75th and 90th percentile
Delayed - Completely left of age line
Interpreations: Cautious/Conservative
Normal: max of one caution
Suspect: two or more cautions/ or one or more delay
Untestable: Refusal scores on one or more or falls delayed on more than two.
Rescreen in 1-2 weeks if suspect or unstestable
Goals of test: Make parents more aware of norms, systematically docuement progress, facilitate early id or delays.
Ages and Stages Questionnaire
Series of dev and social-emotional screening instrument for children from one month to 5 and 1/2 years.
Risk Factors for Divorce
Age - 20s and 30s Often have young children Married average of seven years Lower SES Married as teenagers Short courtship Conceive child before married.
Classification schema for prevention and control of chronic disease
Health promotion (entire populaton; prevent risk factors) –>
primary prevention (one or more risk factors; prevent development of disease) –>
secondary prevention (limited disease; prevent disease progression/recurrence) –>
tertiary prevention (symptomatic or advanced disease; reduce complications or disability)
BMI
weight in kg / height in m squared
Four disclaimers:
-It may over estimate body fat in athletes
-It may underestimate body fat in older persons
- Should not be used in pregnancy, except in pre to pose comparisons
-Endurance athletes should not be assesses using BMI.
>20 = underweight
20-24.9 = normal
25-29.9=preobese
30-34.9 = Obese class I
35-39.9 = Obese Class II
Four subgroups whom clearly benefit from statins
- ) clinically evident ASCVD
- ) Primary LDL that is > 190
- ) Type I or II DM and LDL > 70
- ) 10 year risk of ascvd of >7.5% and an LDL of >70
Z distribution
Special case of normal distribution w/ idealized mean of 0 and S of 1.
Need normal sample sizes > 100
Z score of 1.96 = 95% C.I.
Critical region
Alpha
Area under curve that include unlikely sampling outcomes if null is true.
i.e. if alpha = 0.05 anything >1.96 will be in the critical region.
1 tailed - don’t divide alpha by two and focus on one side (positive or negative). 5% in one tail. z = 1.65
2 tailed - Normal distribution. 2.5% in each tail. a =1.96
Student’s T Distribution
Used w/ smaller samples (N30
Type 1 Error
False positive
Type 2 Error
False negative
Observational Study
Patients observed and outcomes are measured. No attempt is made to affect the outcome.
Positives: probability sampling, great intro tool, answer some questions that controlled can’t due to morals/ethics
Negatives: low validity across cultures, correlations no causations, rely on self-reporting.
Trend
Longitudinal study that measures changes in a population over time.
I.e. Survey of college freshman each year.
Cohort
Longitudinal study that measures Changes and follow a particular population over time.
I.e. 25 MS1’s in 2014 and 25 MS2’s in 2015. Can be a different individuals, but same population.
*Boards often state cohort, but don’t differentiate from panel.
Panel
Longitudinal study that measures changes in the SAME PEOPLE over time.
I.e. 200 Diabetics in 2013 and same 200 diabetics in 2014
*Boards often state cohort, but don’t differentiate from panel.
Qualitative
High valididty. In depth/ nuanced
Quantitative
High reliability. Generalized sampling.
Nomothetic Causation
- )Correlation/Association
- )Temporal Order
- )Non-spuriousness
Clinical Trial Phases
Phase I - Safety and side effects
Phase II - Ideal dosing
Phase III - Experimental vs. control
Phase IV - continued evaluation of FDA-approved therapy.
Hawthorne effect
Researcher attention affects behavior
External invalidity
Lack of applicability to real world
Internal Invalidity
Anything other than the stimulus that influences results.
