internal med week 1: intro & epigenetics

what is health?

state of complete physical, mental, & social well-being (biologic, psychologic, emotional, spiritual, & sociologic)

what is used to determine health status of nation?

- birth/death rates

- life expectancy

- quality of life

- morbidity from specific diseases

- risk factors

what is disease?

- biologic or psychologic alteration --> malfunction of body organ/system

- biomedical condition w/ objective data

what is illness?

- sickness or deviation from healthy state

- perception & response to not being well

what is the difference between disease & illness?

illness is broader than disease

what is the psychoneuroimmuology?

- neural, endocrine, enteric system all communicate w/ immune system via peptides

- ex: under stress --> immune system lowers

what are the two axis involved in health & illness that have integrated?

- hypothalamic-pituitary-adrenal axis

- neuro-endocrine-enteric axis

what is the quantum model of health & disease?

dynamic & ever-changing energy field in body --> impacts health

- low vibe --> disease

what is consciousness-based health care?

- sense of awareness & being --> maintain & restore health & well-being

- adjust mindset --> affects performance

what are examples of acute illness?

- insect bite

- feeling unwell after something made you angry

what is acute illness?

- illness/disease w/ rapid onset & short duration

- end in full recovery & previous levels of functioning

what are the phases of acute illness?

- physical symptoms

- cognitive awareness (symptoms have meaning)

- emotional response (ex: denial, fear, anxiety)

what is subacute illness?

longer than a few days but shorter than months

what is chronic illness?

- permanent impairment or disability

- residual physical or cognitive disability

- need for special rehab or long-term med management

what is the top cause of morbidity & mortality in the U.S.?

chronic illness

what is premorbid personality?

patient's personality before illness

how would a dependent-type personality react when ill?

needs large amt of advice & reassurance

how would a narcissistic personality react when ill?

concerned abt meds or taking off work

how would a stoic person react when ill?

will not admit being sick

what are common reactions to illness?

- fear/anxiety over loss of control

- denial (unconscious defense mechanism), noncompliant

what is pathology?

investigates disease: the structural & functional changes in body caused by disease or trauma

what is pathogenesis?

development of unhealthy conditions or disease

how does the international classification of impairments, disabilities, & handicaps go?

disease/disorder --> impairment (functional/loss on organ level) --> disability (activity/limitation on person level) --> handicap (social disadvantage on societal level)

what are examples of cognitive disability?

- depression

- alcoholism

- schizophrenia

- cognitive impairments

what are examples of military personnel & veterans' disability?

- traumatic brain injury

- amputation

- PTSD

what are executive functions?

cortical functions involved in formulating goals & planning, initiating, monitoring, & maintaining behavior

what does behavior entail?

- overt motor

- affective

- social

what is complex problem solving?

- orchestration of info

- effective handling of new info

what happens when complex problem solving is impaired?

- concrete thinking

- can't determine relevant vs irrelevant

- erroneous application of rules

- hard to generalize from 1 situation to another

what happens when patient is deficit in executive functions?

- inert or apathetic

- from right hemisphere lesion, apraxia, unilateral neglect

what is info processing?

- speed w/ which info travels from 1 part of brain to another (& amt of info)

- efficient transfer of info

what are factors that could interfere w/ info processing?

- noise

- external stimulation

- presenting more than 1 kind of info

- trauma

what are memory deficits?

- result from a failure to store or retrieve info

- info must have been learned first

- acquired, not developed

what is a learning disability?

- difficulty acquiring info in specific domains (ex: reading, spelling) in a person w/ normal or near-normal intelligence

how do learning disabilities manifest in a patient?

- noncompliant

- tardy/absent

- overly anxious

what does the international classification of function, disability, & health (ICF) framework do?

- classify & code info abt health

- provide standard language

- shift focus to life & function

what does the host factors of the ICF framework consist of?

- environmental factors (physical environment, attitudes of others, policies)

- personal factors

what does body functions & structures in ICF framework mean?

- physiologic or psychologic functions of body systems or parts

- impairments (problems in body function or structure)

- ex: range of motion limitation

what does activity in ICF framework mean?

- execution of specific tasks

- ex: walking

what does participation in ICF framework mean?

- individual's involvement in life situations

- social roles

- ex: working

what is the difference b/t traditional medical model & ICF model?

- traditional: etiology, pathogenesis, diagnosis, & prognosis

- ICF model: impairments, interventions, desired outcomes, & function limitations

what are examples of health promotion methods?

- health screening

- wellness

- safety

- stress management

- support groups

what are non-communicable diseases?

lifestyle/chronic

what is health promotion built on?

- self-responsibility

- nutritional awareness

- stress reduction & management

- PA & exercise

what is primary prevention?

- removing/reducing risk factors in susceptible populations

- ex: good nutrition, using seatbelts)

what is secondary prevention?

- promote early detection of disease & employ preventative measures to avoid further complications

- ex: skin tests, screening, healthcare provider ref to PT

what is tertiary prevention?

- limit impact of disease

- rehab

- return person to highest possible functioning level

- prevent severe disabilities

- ex: radiation, chemo

what is genomic variation?

sequence diff among individuals (less than 0.1%)

what are genomes?

all DNA on 23 chromosomes + DNA on circular chromosomes of mitochondria

what are the 3 major categories of genomic variation?

- changes in single base pairs (polymorphism)

- insertions & deletions of a small or large # of base pairs

- structural rearrangements on a chromosome

what is heritability?

proportion of variation in phenotype attributable to variation in genetic factors

what can genetic factors influence?

- disease risk

- severity & progression of disease

- variation in response to exercise & rehab programs

what are the social structures that influence individual?

- individual

- fam

- community

- society

what are the levels of organization?

- atom

- molecule

- macromolecule

- organelle (ex: mito)

- cell (ex: muscle cell)

- tissue (ex: muscle tissue)

- organ (ex: stomach)

- organ system (ex: digestive system)

- organism

what is epigenetics?

- how bio (internal) & environmental (external) signals determine gene expression

- reversible heritable mechanisms bc no alternation to DNA sequence

what do epigenetic signals do to impact gene expression?

prompt changes in methyl groups attached to gene --> upregulating or downregulation

what does the physical environment of epigenetics consist of?

- built environment (surroundings that support human activity: live, work, play, ex: classroom)

- natural environment (ex: AC in classroom)

what does the internal environment of epigenetics do?

- affect physiologic function

- automatic negative thoughts & stress --> cellular incoherence & increased cortisol --> immune system insensitive --> unchecked inflammation

what does the internal environment of epigenetics consist of?

interaction of attitudes, thoughts, emotions, & feelings

what does the external environment of epigenetics consist of?

- air

- water

- food

- toxins

- social network

- community

- sense of purpose

- spiritual beliefs

what does geographic locations in epigenetics consist of?

- community (where ppl live, work, & play)

- geographic & political climates

what is occupational disease?

causative agents that are environmental contaminants

which epigenetic factor has the most adverse influence on health?

socioeconomic status

who is the fastest growing population in need of health care? why?

- homeless & unsheltered ppl

- declining public assistance

- shortage of affordable rental housing

- increased poverty

what are health disparities?

differences in individual or regional community health due to lack of access, high cost, etc.

what are some examples of social determinants of health?

- air & water quality

- access to parks

- language diff

- access to nutrition

what factors does social network include in terms of impacting health?

- cultural

- socioeconomic

- political

- religious

- geographic

- psychologic

what are environmental barriers to health care?

- eating behavior

- grocery store proximity & fresh food availability

- exposure to art, architecture, & music

- incentives to exercise

what is eating behavior based on?

- food supply trends

- nutritional content of foods

- larger portion sizes

- eating out

- TV & ads & media

how does exposure to art, architecture, & music affect healthcare?

- increase PA

- mental health improvement

what is cultural relativity?

response based on cultural influence

how can cultural factors prevent disease?

ex: religions that forbid drinking & smoking

what is transnational competence?

- address issue of physical & mental health along w/ experiences related to geographic dislocation & unfamiliarity

- ex: immigrants

what are examples of adverse childhood experience? what can they lead to?

- abuse & household dysfunction

- drug & alcohol use & addiction, obesity, autoimmune disorder, suicide, etc.

what is the difference between race & ethnicity?

- race: physical difference

- ethnicity: shared culture (language, practices, etc.)

how do dynamic environments provide an advantage?

phenotypic switching by epigenetic inheritance

what are the different generation names?

- matures (1900-1946)

- baby boomers (1946-1964)

- gen x (1965-1979)

- millennials (1980-1999)

- gen z

- homelanders

how do the matures approach healthcare? how about the baby boomers?

- passively

- question authority --> their offsprings will seek variety of treatment

what are the theories of aging?

- gene mutation theory (programmed-based)

- planned obsolescence (programmed-based)

- damaged-based (wear & tear, error, free radical)

- telomere/telomerase

what does it mean for aging to be programmed-based?

- genetically driven

- biological clock

what is the telomere/telomerase theory?

- telomeres make sure sequence lost is noncoding

- as they shorten --> they determine how long cell functions --> apoptosis

- if telomere becomes too short --> no more protection

- telomerase rebuilds telomeres in germ & cancer cells

what is the difference b/t centenarians & supercentenarians?

- centenarians: 109 yr

- super: 110 yr+

how does processed food impact epigenetics?

pro-inflammatory --> ruin gut lining --> intestinal permeability --> gut associated immune regulation disrupted --> potential toxins --> activate hypothalamus-pituitary-adrenal axis (stress), alter neurotransmitters & immune function

what does the enteric NS consist of?

- hypothalamus-pituitary-adrenal axis

- vagus nerve

- amygdala

what does the enteric NS do?

- neurons in gut

- storage reservoir

- neurotransmitters production

- gut --> brain

why does the body need cultured foods?

- probiotics: provide living organisms to microbiome

- prebiotics: needed by living organisms, provide nondigestable fiber

why is exercise considered a systemic stressor?

leads to epigenetic adaptations in tissues such as skeletal muscle & adipose

how do epigenetic marks of obesity in utero & early life impact individuals?

- increased obesity

- can transmit transgenerationally

what is DNA methylation?

epigenetic modification of how DNA is read & expressed w/o altering sequence

what are microRNAs?

non-coding

what is the process of gene expression?

DNA --> transcription to mRNA --> translation to protein

what is preproinsulin?

immature insulin

what is the difference b/t signal transduction vs gene expression?

gene expression takes longer

what are the transcription factors of insulin?

- PDX-1

- mafa

- beta2

in the analogy of a key & a lock, which is the insulin promoter & which is the transcription factors? what step do they play a role at?

- key: factors, b/t transcription & translation

- lock: promoter, b/t transcription & translation

what is the process of insulin production?

insulin gene --> transcription to preproinsulin mRNA --> translation to preproinsulin protein

what represents the green light in insulin production? what step does it play a role in?

- eukaryotic initiation factor (eLF)

- before translation into product

what are the steps of insulin from preproinsulin?

preproinsulin as signal sequence leaves --> proinsulin as C peptide leaves --> insulin

what pathway is involved in insulin secretion?

ATP-sensitive K+ (KATP) channel dependent pathway

once insulin is secreted, what is involved?

SNAp receptors (SNARES proteins)