In Sickness and In Health Course & Exan Review

What is Health?

A state of complete physical, mental, and social well- being and not merely the absence of disease or infirmity.

How can you achieve good health? What are the 4 domains?

• Physical Health

• Mental Wellness

• Social and economic stability - basic needs

• Joy in practice - those who are providing care

  • If doctors aren’t feeling well, patients will feel that effect

What is the U.S leading cause of Death? 2024

Heart disease - still leading cause of death

Which Disease/s are rising?

Alzheimer’s Dementia - we do not no how to treat this one

There are more and more people out living what diseases?

Heart Disease, Cancer, stroke

Chronic Liver Disease is often due to what? What is Cirrhosis what does it do?

Alcohol use disorder

Cirrhosis is a late stage of chronic liver disease → When healthy liver tissue is gradually replaced by scar tissue which blocks blood flower, making it harder for liver to filter toxin from blood..

Intential self-harm (suicide) is rising from what?

#12 in 2023

Covid is off the top

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What are the determinants of Health

1. Environmental exposure

2. Health care

3. Social circumstances

4. Genetic Disposition

5. Behavioral patterns

What is the biggest component that determines if you are healthy or not?

Lifestyle/behavioral pattern + sleep

What are Factors Influencing Health?

• Tobacco use

• diet

• physical activity

• stress management

• alcohol & drug abuse

• Control of blood sugar, blood pressure, cholesterol

• Cancer screening

• Access to Care

• Income Health Insurance status

• Attitudes towards health care

• Sleep

What are the Social & Environmental Determinates of Health?

Health is more than seeing a doctor, you are healthy because of your lifestyle.

• Doctors and hospitals

• Multiple influences

• Measured in different ways

What are things that influence health?

• regional culture

• Healthy Behavior/attitudes toward health

• Federal, stare and local policies

• Income and education - health literaty

• Presence/absence of health providers and facilities

Why is health and health care different across the US?

What are Blue Zones? What are 3 examples fo blue Zones?

Regions in the world where people consistently live longer, healthier lives.

• Okinawa, Japan - has “no time urgency, likeabillty, turmericl, plant based diet

• Loma Linda, California - Healthy social circle, eats nuts, no smoking, plant-base dieat.

• Sardinia, Italy - High polyphenol red wine, Fava beans, plant base diet, strong family ties

What does Okinawa, Loma Linda, and Sardinia have in common?

• Family

• No smoking

• plant-based diet

• Constant moderate physical activity

• Social engagment

• Legumes

What are the steps to Approaching Ethical Dilemmas?

• 1. Identify the ethical dilemma

• 2. Collect information, assess relevant facts

• 3. Identify stakeholders who will be affected by the decision

• 4. Develop a list of options and alternative

What are the Four Medical Ethical Principles?

• Beneficence - Doing good for people

• Nonmaleficence - when approaching, do you advoid potential harm?

• Justice

  • Personal Justice - Gets divided, into doing the right thing for individuals

  • Societal Justice - Doing the right thing for entire communities (we don’t have enough kidneys to give out, who do we found is more deserving)

• Autonomy - People have the right to make their own decision aboust healthcare. - not families, doctors...etc.

What is the opposite of Autonomy?

Fraternalism

What is Palliative Care?

It is a relief from suffering, it is design to improve the quality of life.

It is about sharing honest information with patient, it is not the same as end of life care

It is making some one conforable without treatment

What is the Oklahoma Advance Directive? When can you fill it out? what does it have?

It is a way patients can state their wishes in advance.

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Has, Living Will, Health Care Proxy, Organ Donations, General Provisions

What is Artifical Nutrition and Hydration for?

Wishes for Terminally Ill, Persistently unconscious or an End-stage Condition - people need to answer what they want in terms of tubes being inserted into them to feed them articically or IV for Hydration

Wha is advance directives

a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.

What are the Barriers to Advance Care planning?

• Clinicians vary in their knowledge, skills and attitudes about completing Advance Directives with their patients.

• Few incentives reaward clinicians for discussing advance Directives with their patients.

• They are concern about legal complexities, especially around the AANH clause

Most patients talk to their familes about it.

The Oklahoma Do Not Resuscitate Document?

It goes into Effect immediately and all it says is, If my heart stops beating, do I or don’t I want to have advance Cardio life support.

• Team will not Follow ACLS protocol to resuscitate

• Allow Natural Death

• May not be for everyone - especially the elderly

Projections?

There is a work force shortage. The U.S will need to hire an additional 2.3 million new health care workers by 2030 to adequately care for populations

What is the largest need for work?

Geriatrics - the care of older Americans

We need more of what? There will by nearly 177,440 new R.N. openings and 86,000 D.D and D.O

Nurses and Doctors

How do we measure Health Status?

• Life expectancy - a community where it is longer, then it is healthier

• Birth and Death Rates - in an area

• Disease-specific morbidity - Heart attacks, strokes, cancer

• Prevalence of Risk factors for disease - obesity, hypertension, tobacco use

• Accessibility and use of healthcare services

• Health Insurance coverage

Health Care Outcomes in Tulsa County? North and South tulsa?

Tulsa county - 14 year longer than North Tulsa, Northeast, and West Tulsa - that has to do with access of care, race, income…

What is Hotspotting?

We can determine where disease rates are highest.

• We can geo code where certain disease appears at high rates

• Good way of bring treatment to those who need it the most

• Maybe it is a place where cardio practice must be

Over the years the United States are facing a what? 70% of Americas are… or…

Obesity Crisis

Over weight or Obesity - measured by BMI (height over weight)

Why does Colardo tend to out preform states in Obesity? What part of the U.S tends to bad with weight?

Active lifestyle

Deep South

Why are obesity rates dropping?

Because of drugs like semaglutide, ozempic, mongroa

BMI Chart read?

BMI - is an…

Outdated way to measure Obesity but it is the most up to date way.

What are Some common Behavioral Illnesses?

• Dysthymic Disorder / non-major depression

• Generalized Anxiety Disorder

• Seasonal Affective Disorder - less light

• Attention Deficit/hyperactivity Disorder

• Social phobias

• Personality Disorders

• Cyclothymic Disorder

What gives rise to all these mental health conditions? and Substance use disorder?

• Genes - both illness specific and non-specitic

• Environment and exposures

Stigma about mental health disorder?

You think you are a failure - these are brain conditions

Mental Illness and Susance Use disorder is not associated with what?

• Moral Failure

• Bad Character

• Inferior people

Mental Illness and Substance Abuse is?

• A brain disorder

• Chronic illness

• Like other illnesses → Response to treatment

What is SMI? What does it reflect?

Serious mental illness, which is define by the length of duration and lost of function. These people won’t be able to function well in life like the other mental illnesses.

Lost of contact with reality - Psychosis

What are the examples of SMI?

• Major Depressive Disorders

• Schizophrenia & Schizoaffective disorder

• Biopolar disorders

• Serious Emotional Distrubance (children)

• Post Traumatic Stress Disorder

• Paranoid and Panic Disorders with psychotic features

People who have SMI life expectancy is generally. … years less than average

25 years

he pesence o SMI is sonly coelaed with what?

Homelessness, substance abuse, and incarceration

What percent of American adults have SMI?

4.2%

What is the number one cause of death in SMI? - will be on exam

Cardiovastular disease, cancer, stroke, same thing as the general population but ALOT younger!

What is Day to day Stress?

Usually tolerable, manages everyday coping skils, resilience

What is Toxic Stress? What does it affect?

It is the constant feeling of serious danger, powerless, and coping skills are lost

• Immune system

• Endocrine system (blood sugar, growth hormone, thyroid levels)

• Epigenetics phenomena

What are the treatments to overcoming Trauma + toxic stress?

Having Strong social connections + support: Peer relationships, building resiliency, calming the brain

• Mental Health Care

  • Office visits

  • Home visits - faith

  • Non-Traditional Therapies

    • Meditations, yoga, mindfulness

  • Medications - anti-depression meds

• Nutritions

• Exercise

Adverse Childhood Experiences - traumatic exposures. What are the 3 categories? 

• people who were abused at home

• neglected

• grew up in household disfunction

What are examples of Adverse Childhood Experience?

• Physical, Sexual, emotional abuse

• Physical, emotional neglect

• Intimate partner violence

• Witnessing parent treated violently

• Substance misues within houshold

• Witnessing household mental illness

• parental separation or divorce

• Incarcerated household member

What is the strongest Adverse Childhood Experience?

Watching a parent get taken by the police at home

People who 2,3,4,5,6 ACEs are much more likely to have what?

• more medical conditions - diabetes, obesity…

• alcohol, drug use, smoking

  • ways for people to cope

Alcohol Use disorder?

Chronic, relapsing brain disease that characterized by compulsive drug seeking and use, despite harmful consequences

Why is Alcohol Use disorder is a brain disease?

B/C drugs change the brain - the structure and how it works

Brain changes can be long-lasting, and can lead to … behaviors

Harmful behaviros seen in people who abuse drugs

What are the most commonly abused substance?

Alcohol

Why do people abuse substanes?

Because it releases dopamine(craving) in our brain

Why does Substance Abuse Matter? Drinking.

30% of Americas will engage in harmful drinking patterns, and 6.3% will suffer from SUD. IT is the leading cause of social dysfunction and threat to everyday life.

What is the percentage of college students who meet the criteria for alcohol use disorder?

20%

1 in 4 college students report academic consequences from drinking, including what?

• Missing class

• Falling behind in class

• doing poorly on exams or papers

• Receiving a lower grade overall

Cannabis has a duel function, what is it?

• low doses - relaxing

• Higher doses - risk for psychosis

What does Cannabis do? Long term use?

• May help or worsen Anxeity and Pain.

• Alter CNS transmission

• Raise heart rate

• Marijuana, lungdamage

• Affects short-term memory + learning long term apathy, recall

What is the cyclical Vomiting Syndrome?

Heavy users of Cannabis → usually in emergency rooms

Physical Dependence?

If you keep using a drug and you stop, you’ll go into an withdraw, that’s why it needs to be taken out little by little

Tolerance?

When you have been taking a certain amount of drug, but it’s no longer doing it for you, so you need a higher dosage

Addiction

Means you are engaging in harmful behavior, despite knowing it’s harmful to you

SUD is often Chronic and may be curable. How?

Takes time, community suppport, family support

Alcoholism and substance use disorder relapse rates are similar to … and..

diabetes and hypertension

Relapse does not mean?

treatment failure, lapsing back to drug use indicates the treatment needs to be or adjusted or that another treatment should be tried

From 2011 the death rate from prescribed opioids has slightly slowed because of what?

• Better clinician education

• Use of prescription drug monitoring programs

However over the pat 5 years, opioid-related deaths are stubbornly climbing due to what?

• Largely due to heroin overdoses

• Illegally distributed synthetic opiods such as fentanyl compounds

Drug related Deaths in Oklahome

What drugs are on the rise in OK? - on exam

• Methamphetamine - continues to rise, cheap to make

Disparities, tulsa like the rest of the U.S is becoming less..

White

Race and ethnicity among providers is changing more slowly than among the …

General population

Non-whites have worse … than white counterparts?

Health (and social) outcomes - because of slavery + marginalizing

Why is there Disparities in HealthCare?

• Mistrust in physicains + hospitals

• Adverse Childhood experiencces

• Non-whites are mindful of the racial discrimination that has shaped our county’s history

National Racial Differences in Poverty Rates, Who is lower?

Black and hispanics + native Americanes

What is Implicit Bias?

Attitudes or mental constructs that affect our understanding, action, and decisions in healthcare - favor our own racial/ethnic group, biases are involuntarily and sometiems demonstrated through microaggressions

May want to help people but favor those of our own race + gender without knowing they are, may offense people

Implicit Bias examples: African-American Patients because?

They are less likely to receive adequate treatmnet of painful conditions - less pain medicine

• Glaucoma

• AIDS

• Migrains headaches

• Postoperative pain

• Angina Pectoris

• Joint pain/arthritis

Implicit Bias examples: Hispanic Patients

B/C they are less likely to utilize primary care health services, more likely to use utrgent/emergency services

• Translation issues - better when info is deliver

Caring for LGBTA individuals

They feel marginlzed - we need to understand the struggle that most of them have experienced in their lives, be aware of the unique mental health and substances use disorders affecting LGBTQ population,

We need to be cultural competence

How do you achieve Cultural Competency, questions to ask?

• Seek permission first

• How much do you wish to know?

• Who speaks for you?

• What are your greatest concerns/fears?

• What can I do that will help you the most

Tensions in HEalth Reimbursement?

• Fee for service

• Value Based Care

What is Fee-For-Service?

• You show up - insurance pays

• Incentive to see more patients/hopitalizations

Value Based Care?

• Pays for quality of care, not quantity

• Patient experiences matters

• Hard to measure quality & experience

What does this graph show?

The price of health care is out pacing the cost of inflation and earnings. leading to alot of medical debt

U.S Poveerty

People dont chose to be their, there is not enough working jobs, they are stuck there

What is the Cycle of Poverty?

Situational Poverty?

Temporary form of poverty, that happens when a person or famil'y’s financial stability is disrupted by a specific event

what do people who are Inter-Generational poverty focus on? What do they fail to see?

Immediate needs vs. planning for what might be mportant for the future

The value of planning and Achievement

• Hard work in school, job promotion

• Reading to children

• Serving healthy foods

• income savings for retirement

• Preventative health care

MAslow’s Hierarch of Needs

What is preventive Care?

We screen people for multiple things before it becomes a problem.

What is Modern Epidemiology questions asked?

• Who is sick?

• What are their symptoms?

• When did they get sick?

• Where could they have been exposed to the cause of the illness?

What is public health? Can be sonsored by what?

Widespread efforts to reduce the risk of preventable disease and disability

Public (government) and private interests

What is population health?

Works to modify, reduce, or eliminate signs and symptoms of disease among groups or populations of individuals - same as public health but narrow down to a specific population