HEAL 2600 Midterm

Health

Health

the normal physical state i.e, the state of being whole and free from physical and metal disease or pain, so that the parts of the body can carry on their proper function

WHO definition:

• state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. it is a positive concept emphasizing personal resources, as well as physical capacities.

Health Promotion

the process of enabling people to increase control over, and to improve, their health

emphasis on lifestyle and the power of the individual to influence their health and well-being

Prerequisites for health

Peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.

Health concept

is individualized, health is seen as they functional ability, disease-preventing lifestyles

Leading health problems

these are defined in terms of behavioral risk factors:

• smoking, poor eating habits, lack of fitness, drug abuse, alcohol abuse, poor stress coping, lack of lifeskills

Health Canada’s 12 determinates of health

Healthy behaviours: Outer and Inner, Childhood experiences, education and literacy, gender, culture, social environment, biology and genetic endowment, income and social status, employment and working conditions, access to health services, physical environment, social support networks

What are the SDOH?

Economic & Social conditions

they shape the health of individuals, communities

Life course Health perspective

The framework was developed by Halfon & Hochstein (2002)

The major concepts are:

• there are multiple determinants of health throughout life

• health is seen as a process rather than an outcome

• health trajectories or pathways are molded by:

  • risk factors

  • protective factors

  • early life experiences

• early advantages / disadvantages can be compounded over a life time

Life course Health development (LCHD)

Cumulative mechanisms

• effects that are dose or exposure dependent, regardless of age or developmental stage

• example: environmental tobacco smoke (ETS)

Programing mechanisms

• effect of exposure to risk during sensitive or critical development periods

• can be physical (ex. prenatal) or social (ex. life transition such as starting school)

Example: maternal depression

• depressed mothers

  • less attentive, less positive, less engaged

• infants of depressed mothers

  • shorter attention spans, elevated cortisol levels (stress hormone), elevated heart rates

• developmental outcome

  • children’s cognitive ability (thinking skills) at age four predicted by maternal depression during infancy

Social determinants of ill health

Just as there are health behaviours, unhealthy behaviour can arise from otherwise healthy social sciences (education and jobs can be a source of stress and anxiety)

Stress

A non-specific somatic response to positive and negative situations (selye 1960)

Stressors

Negative life events or circumstances that occur in the lives of individuals (ex. The loss of a loved one)

Distress

Related to anxiety and other health problems (ex. Physiological ailments)

Eustress

Positive stress related to excitement and positive emotions

Acute stress

Short term stress (ex. Tests and exams)

Chronic stress

Long term stress (long lasting life factors)

Early physiological stress measurements

Pulse, respiration rate, blood pressure, sweaty palms, related to fight or flight response (discovered by Walter cannon)

• before they focused on negative relations to stress and wellbeing

• Negative stressors

• Physiological indicators (were thought to be invalid)

• Animal research - measured physiological indicators

Modern physiological measurements

stress hormone measurements (ex. Cortisol - secreted through the adrenal glands), telomeres length

• Negative and positive stress

• Additional physiological factors

• Psychological indicators with great emphasis on ethical human research (ethics have been heavily emphasized throughout the years)

• General consensus between animal and human research on stress

Modern psychological measurements

In more modern times psychological factors have been greatly accounted for and much research has been done to identify these factors

• rapskin and fisher (1992) - number of stressful life events experienced

• Harlow and colleagues - singual stressful life events (ex. Widowhood)

• Ludwig and colleagues - personal health crisis

• Glass and colleagues - multiple stressful life events (ex. Widowhood and divorce)

• Cone and colleagues - perception of stress

Research on stress and health

Stress has now become linked to a number of physiological health issues that include but are not limited to cardiovascular and age related issues

Research study examples:

• folkman (1984) - appraisals of control: how much control do you feel about certain events

• Frankenhaeuser (1986) - hormonal response and emotions: cortisol and epinephrine on psycho-social scenarios

• Tavazzi et al (1987) - human heart failure and stress (elevated cortisol)

• Rahe and Holmes (1989) - change I’m physical health status

• Glass, Karl, and Berkman (1997) - most stress and more symptoms of depression appear

• Anderson and Chesney (2002) - stress and hypertension (elevated cortisol)

• Hawkeye et al (2005) - shortened telomeres/aging and stress

Theory of planned behaviour

Suggest that behaviour is determined by intentions, attitudes (beliefs and behaviour) and subjective norms (beliefs about others attitudes towards behaviour)

Outer influencer

Development of mechanisms that allows for the management of stress, gaining the feeling of having Perceived Control of the situation (coping mechanisms - games, sports, exercise, planning ahead)

Perceived control

The basic belief that you have control over a given situation which manifests itself in two main forms

Primary control

Proactive attempts of individuals to influence and alter their environments in ways that are aligned with their wishes “changing the world”

Secondary control

Changing the way one thinks in order to adapt to the environment “changing the self”. This manifests itself in 4 different types

Predictive control

Gaining a sense of control by having knowledge of upcoming negative life events

Illusory control

Gaining a sense of control by believing in luck, fate, or chance (religious beliefs, lucky rabbits foot)

Vicarious control

Afflictions with powerful others (thought that others are better in this scenario)

Interpretive control

Reinterpretation of negative situations to see if their positives (finding the silver lining)

Viktor E. Frankl

Father of secondary control

• an auschwitz survivor who used his knowledge of psychology to teach his fellow inmates proper coping mechanisms for their situation. He gave them a sense of control over their situation and was credited by those he helped with giving them the motivation to survive

Research supporting perceived control

The theory of planned behaviour and the idea of perceived control is the culmination of decades of research and pasta theories. These research papers conclude that those who feel that they are in control over their situation feel less stressed and subsequently are healthier

Research examples:

• Early 1950s - Behavioural/observation - studying the outward behaviour of individuals

• Late 1950s - social behavioural observations - outward behaviour in a social / group environment

• 1960s - advent of perceived control

  • Rosters internal vs external locus of control: believe that you have the power to control things in your own life vs others are in control of your life

  • Seligman and Maiers learned helplessness in animals: the randomness of negative situations causes a learned helplessness or lack of effort to change their situations

  • Abramson, Garber, and Seligmans theory of attribution: examines three dimensions of attributing control of an event:

    • Internal vs external - am in control, or is someone/something else?

    • Specific vs Global - is this true of just this one situation, or is it more general?

    • Stable vs unstable - will things be like this forever or is there potential for changes?

  • Rothbaum, Weisz, and Synders two process model of control

Underlying premises

Basic biology and organic makeup are a fundamental determinant of heath

Genetic endowment provides an inherited predisposition to a wide range of individual responses that affect health

Consists of key subjects called infant and adult screening

Infant screening

There are over 50+ tests for infants at birth. However not all are done and this discrepancy is not good and should rather become standardized

• some provinces do some tests while others do different tests

• In Manitoba for example, cystic fibrosis testing only began in 2011

• There is far less testing done in the territories

Cystic Fibrosis (CF)

Affects the lungs

Difficulty breathing

Coughing up mucus

Frequent lung infections

Save babies through screening foundation Research

Two cases studies in Ontario involving:

• Long-chain hydroxyacyl-CoA dehydrogenase Deficiency (LCHADD)

• Medium-chain Acyl-CoA dehydrogenase deficiency (MCADD)

This went undetected and led to disastrous consequences

These case studies help us to understand genetic diseases

Save babies through screening foundation Treatment

Early diagnosis and prompt care are important

• this allows most babies to live normal lives

• Without this it can lead to genetic disorder and death

Can lead to undetected metabolic disorders if not detected

• ex. “Crib death” before 4 months of age

• Can be detected through proper screening procedures

Rapid specimen handling is important

Recovery options:

• dietary restriction / supplementation (vitamins)

• Special formula

• Medications

1 in 1500 babies will have these metabolic disorders and they are easily preventable

• delays can cause disastrous results

Save babies though screening foundation PKU

Detection of a specific enzyme that is used to metabolize pheynlamine (amino acid)

• needed for normal growth

• Has to be detected within 24-48hrs birth

• Sometimes a retest is needed

  • The lab suspects abnormal results (ensure they did it right)

  • Has to be done as soon as possible (time is of the essence)

• Obtaining test results

  • If not informed than there is a likelihood that there is nothing wrong

  • Parents have the option to reach out to obtain the results

• Newborn tests

  • Can obtain up to 50 genetic disorders

Supplemental Newborn screening kits

This process can be done at home:

• expensive

• Unattainable for impoverished individuals

• Impoverished children are more likely to die from metabolic diseases due to lock of infant screening

• Has social determinant interactions

• Can be used to obtain all 50 tests

Dr. Richard Gordon

Stereotypical professor

Pioneer of genetic testing for adults

His vision was for people to go to a place that looked similar to an airport baggage claim where all the the machines were lined up to scan us. The scans would be:

• high resolution

• Low risk

• Non-invasive

He wanted 4-D images of the body same as 3D but with the addition of time

• suggested that the time aspect that people will come the same time, and day a year later to see the changes upon getting scanned again

• 3D means only height, width, and length

• The machines would digitally subtract images by using computer software

• If any changes were detected, quantitative analysis would be recorded and involves 3 things:

  • 4D images

  • Aligning the 3D aspects

  • Digital subtraction (time 1 - time 2)

Wanted to have a private clinic with his own machines and business

Adult screening

Nickname: Yupy scams

• Yupy: Young urban professional

  • Lots of disposable income

  • Screening was head to toe

  • Done to avoid potential issues in the future

  • Costed 3400 dollars = whole body scan

Could shift healthcare from treatment based to preventative based

Treatment based

Only when we have symptoms and we seek out help

Prevention based

This is scanning that is done without a definitive cause but is done to prevent further problems

This results in less cost to the healthcare system

Cancer

The public’s most feared disease.

There is billions of dollars spend on cancer research.

• this powerful technology could:

  • Use genetic structure to identify new risk factors

  • Gene shifts, these detect mute changes to genetic code

  • Robotic guided processors to destroy cancer growth

Incipient myopia and PKU

Degenerative eye condition

CT Scan

Known as the EMI scan was developed by the electrical and musical industry

Later known as computed axial tomography

• generated 3D images by taking different 2D x rays, then use the computer to combine those images together to make a 3D scan

• “Graphein = to write, “tomos” = slice, writing slices

MRI: Magnetic resonance images

Is by far the best, it lets you see both the structure and sub structure, very detailed

They are different because they do not use x rays, the machine uses magnetic fields and radio waves, to bounce off the structure of the body that you are focusing on to generate 3D images

It is safer and less harmful, on the one conditions that there is ZERO metal

Underlying premises of Education and Literacy

Enhanced knowledge and skills

Increased sense of control and mastery

Increased job opportunities and income security

Improved access to information

Canadians with higher education

Have better access to healthy physical environments

Are better able to prepare their children for school

Smoke less

Are more physically active

Have better access to healthier foods

Canadians with low literacy skills

Are more likely to be unemployed

Are more likely to be poor

Are more likely to suffer from ill health

Are more likely to die earlier

Education relates to absence from work

Number of lost workdays inversely relates to education

Having attained an elementary school education relates to being absent from work 7 days per week

Having attained a university education relates to being absent from work less than 4 days per year

Early school readiness and later outcomes

Interventions:

• head start program

• High scope Perry preschool project

Dropping out of school:

• risk and protective factors

Education & income

These are strongly related

One of a proxy for the other

The downward spiral to ill health

High education & income = good health

Low education & income = low health

Breaking the Cycle: The war on poverty

1964 - Lyndon B. Johnson

A legislation introduced due to the national poverty rate being 19%

This directed money towards education and health care to fight poverty

The War on Poverty: The Head start Program

Started in the 1960s

It was an 8 week summer program that was designed to help impoverished children to stay in school by meeting their emotional, social, health, nutritional, and psychological needs

The long-term success of the program has come under scrutiny \

The War on Poverty: The high Scope / Perry preschool project

This was a high-quality preschool program for young children that were living in poverty

Also aimed to keep children in school

A scientific experiment that showed both short and long term benefits

The high scope / Perry preschool project (methods)

• a 2 year program for impoverished 3-4 year old African American children in Michigan who were assessed to be at risk for school failure

• They were randomly assigned to the preschool program vs not

• Teachers implemented the program daily for 2.5hr classes, and visited the families weekly

• The teachers had bachelors degrees and certification in education, and incorporated small and large group activities

• The data was collected annually when the children were ages 3 to 11 and then again at ages 14,15,19,27, and 40

• A summery of the findings revealed beneficial effects of the program in multiple domains

The High Scope / Perry major project (findings)

Outcomes:

• Completed regular high school

  • Program: 65% (84% females, 50% males)

  • No Program: 45% (32% females, 54% males

• Employed at age 40

  • Program: 76%

  • No program: 62%

• Earned 20K at age 40

  • Program: 60%

  • No Program: 40%

• Arrested > 5x by age 40

  • Program: 36%

  • No program: 55%

Significantly less of the program group required help from social services

A higher percentage of the program group owned their own homes

Health outcomes were not measured

The High Scope / Perry Project (conclusions)

Early intervention has strong positive short-term benefits:

• increased IQ, vocabulary and literacy

• Less grade repetition

• Positive attitudes towards school (in both children & parents)

Longer-term benefits include:

• a high school education

• Employment

• A higher income

• Crime prevention

The High Scope / Perry Project (Cost/benefit analysis)

Price: 15,166.00 per participant

• program participants earned 14% more than non program participants over their lifetime

Estimated savings: 244,812.00 per participant

• this money is saved from social assistance

• Results in less crimes and payment of taxes

The High Scope / Perry Project Q&A #1

Sample Size

Isn’t the sample size of 123 children too small to have confidence in the findings?

• as the sample size becomes smaller the group differences have to be larger to determine statistical significance

The High Scope / Perry Project Q&A #2

Generalizability

Can the results of the study be to general to other programs?

• it can be generalized but only if the intervention is similar to high scope/ Perry project

  • Teachers have to have the same training

  • Same run length

  • Designed for 3-4 year olds

  • Participatory education approach

    • Group work

  • Teachers visit them families at least every 2 weeks

  • Include daily class of 2hrs or more

  • Has to essentially be identical

The High Scope / Perry Project Q&A #3

Outdated

Did the high scope / Perry program occur too long ago to apply to current programs?

• No, it is not outdated

• There is no reason to assume that the basic principles of human behaviour and education have changed dramatically overtime

The High Scope / Perry Project Q&A #4

Gender differences

Why did the high scope / Perry project affect males and females differently?

• females were more developmentally ready as males were not

Dropout

High school leaver (formal definition)

Zeman (2007): a national study of 15-19year olds across Canada found that there were two main risk factors for leaving high school are:

• low income and being male

  • Boys tend to leave high school at a higher rate and are less likely to continue on to post-secondary education

In Manitoba & Ontario

• girls are more likely than boys to complete high school

• Girls are more likely than boys to go to university

• For high school graduates who do not attend university, girls are more likely than boys to go to community college

Work & School

Bushnik (2003)

• A study of 18-20 year olds across Canada begun in 2000

• Across Canada 69% of students worked in their last year of high school

• In Manitoba,

  • 27% did not work at all

  • 19% worked 1-10ths a week

  • 25% worked 10-20hrs a week

  • 20% worked 20-30hrs a week

  • 9% worked 30+hrs a week

Risk and Protective factors

Raphael (2016 p. 252)

• is working for pay while in high school a risk or a protective factor for dropping out?

  • The study found that 48% of students in their last year of high school who did not have a job, ended up dropping out

  • Students who worked 1-9, 10-19, 20-29, and over 30hrs a week experienced a reduced dropout rate of 16% or less

Other Risk factors (for dropout)

Bushnik (2003)

• geographic location (northern Canada)

• Family composition

• Large number of school changes

• Grade repetition

• Having an older sibling who has dropped out

• Misbehaviour

• Poor attitude towards school

• Low grades

How does Gender affect health?

Men are more likely to die premature than women

Cancer death rates have fallen for men but not for women, largely due to teenage girls being more likely to smoke than boys

Women generally live longer then men, but suffer more from stress overload, certain chronic conditions, family violence, and depression

• 2x as many females suffer from depression

Depression

A serious medical condition that affects the body, mood, and thoughts

• how someone thinks, eats, and self-perception

• Not:

  • Sign of personal weakness

  • A mood that passes

  • A condition that can just be wished away

Without treatment, can last up to weeks, months, and years

Treatment options:

• therapy in many different forms

1 in 5 suffer from depression at any given time

Major depression disorder

Also called clinical depression

Some of all the symptoms

One or several episodes over a lifetime

Interferes with daily functioning

Surpasses the ability to work, study, eat, sleep, enjoy social activities

May never get better

Very disabling

Dysthymia disorder

Also called mild depression

Similar symptoms as clinical depression

Long lasting (2+ years)

Overall sense of fatigue, lack of joy/enthusiasm

Symptoms typically last longer

Not veer disabling

Kept from functioning well and enjoying life.

Manic depression

Also called bipolar disorder

Alternation between extreme mood swings

Depressive symptoms to euphoric symptoms

• Euphoric symptoms:

  • High activity: racing thoughts

  • Extreme happiness

  • Talkative

• Depressive symptoms

  • Irritable

  • Impulsive; poor judgement

  • Rapid cycling (from a very intense high to a very deep low) (‘Up/Down”

Symptoms of depression

For all types of depression (not everyone will have the same one and will experience them in differing severity levels)

• mood (anxiety)

• Anhedonia (hobbies are not enjoyed)

• Negative emotions and self regard (low self esteem, crying, guilt, worthlessness, and helplessness

• Sleep (to much or to little)

• Appetite (overeating and under eating)

• Energy (low energy, fatigue, slowed down)

• Suicidal thoughts (attempts)

• Concentration (trouble focusing)

• Physical symptoms that do not respond to treatment (headaches, chronic pain, digestive pains also called stomach migraines)

Co-morbidities of depression (anxiety disorders)

PTSD

OCD

Panic disorder

Social phobia

Generalized anxiety disorder

Serious physical illness - heart disease, stroke, cancer, HIV, diabetes, and Parkinson’s

These problems accompany depression and need to be addressed separately

PTSD

Post Traumatic stress disorder

• develops after exposure to a terrifying event or ordeal

  • Grave physical harm occurred or was threatened

  • Common in solders

  • Examples:

    • Mugging, rape, natural disaster, and traffic accident

Occurs when people are reliving the traumatic event

There is a feeling of an earthquake in their chest

Can also be chronic:

• child trauma

• Abuse

• Emotional numbness

• Often sleep disturbances

OCD

Obsessive compulsive disorder

Unwanted thoughts (obsessions)

• repeat a certain behaviour (compulsion: handing washing, door locking)

These behaviours inhibit tests in there daily life

Often know that what you are doing is not normal but is uncontrollable

Panic disorder

Symptoms:

• There are no helpful thoughts

• Not relaxed

• Flushed

• 90% of people believe they are having a heart attack

• Upset stomach

• Repeated episodes of fear

Social Phobic

Sign that anxiety and discomfort related to a fear of being embarrassed, frightened, judged, or scorned

Generalized anxiety disorder

Characterized by chronic anxiety, exaggerated worry/tension even when there is little or nothing to avoid it

There body is asleep, but the mind is awake

People with this suffer in high amounts

Gender differences in depression

Women are more predisposed to depression than men (2:1)

• noticeable differences begins at 11-14 years old (puberty)

• Hold true thought out all ages

Gender differences in symptom expression

Men typically use these to cope:

• substance abuse (drugs and alcohol)

• Escapism (addiction)

• Risk taking (addiction)

• Irritability

• Abusiveness (domestic violence)

Women typically use these to cope:

• rumination (think about it non-stop)

• Sleeping excessively

• Disordered eating (anorexia, bulimia)

• Heaviness in limbs

• Sensitivity to rejection

What is sex?

Is about biology

Secondary characteristics (these distinguish biological components but remain separate from reproductive system and emerge around puberty

• breasts

• Facial hair

• Body hair

• Enlarged larynx “Adam’s apple”

• Stature

Primary characteristics

• genitalia at birth

What is Gender?

Is socially constructed

WHO definition:

• to describe the characteristics, roles, and responsibilities of women, men, boys, and girl, which are socially constructed. It is related to how we are perceived and expected to think and act as women and men because of the way society is organized, not because of our biological differences

Health Canada definition:

• refers to an array of socially constructed roles and relationships, personality traits, attitudes, behaviours, values, and relative power and influence that society ascribes to the sexes on a differential basis. It is relational. The roles and characteristics do not exists in isolation, rather they are defined in relation to one another through relationships between women, men, boys, and girls

Gender differences in depression (psychological

• personality traits - the “big five”

  • Openness

    • Open to experience

    • Ex. Appreciation of art, and adventure

  • Conscientiousness

    • A tendency to show self discipline, show vigilance

  • Extra version

    • Energy, Sergeancy, more positive than negative, tendency to seek energy in social situations

  • Agreeableness

    • A tendency to be cooperative rather than antagonistic towards others

  • Neuroticism

    • A tendency to experience unpleasant emotions such as anxiety, anger, depression

Women often score higher on neuroticism, extroversion, and agreeableness

Gender differences in depression (Social)

Problematic relationships

Social support

Social roles (women tend to be more caregivers)

Negative life events

• death in the family

• Bad traffic accident

• Breakup

Sex differences in depression

Biological basis for differences in depression

• genetic predisposition (can sometimes skip a generation)

• Hormones

• Brain structure

Depression prevention

Find ways to handle stress and improve self-esteem

Take good care of yourself:

• sleep enough

• Eat well

• Exercise regularly

Reach out to family and friends when times get hard

Get regular medical checkups, and see your provider if you don’t feel right

Get help if you think you need it. If you wait it could get worse

Health belief model (HBM)

Dadgarmoghaddam, khajedaluee & khadem-Rezaiyan (2016)

Modifying variables

• Perceived seriousness

  • Needs to be viewed as a serious problem in order for change to be brought about

• Perceived susceptibility

  • Not going to change as they don’t see it as a threat

• Perceived benefits

  • Need to believe it works, and is about the beliefs of the effectiveness

• Perceived barriers

  • Wants to use the method but they are embarrassed about it, can be psychological/physical

• Self efficacy

  • Persons confidence to perform the desired behaviour in there self

• Cues to action

  • This motivates the to obtain/make the chance

    • Commercial, environmental

Continuity of care

Related to health services

• is health care that is provided in abstract ways outside of the norm

• An extension of health care to homeless that are terminally ill

Health services

PHAC definition:

• encompass those options that contribute to population health. These options are designed to maintain and promote health, prevent disease, and to restore health and function. Contains a continuum that includes treatment and secondary prevention

Secondary prevention

Trying to detect a disease early that has already developed

Most people are afflicted already

Income and social status

According to PHAC

• results in more control over life circumstances

• Better health

  • Does not affect only poor people

  • Affects everyone on the socioeconomic spectrum

Hirai et al (2006) - Case study

What is a good death?

Purpose

• to identity the components of a Japanese “good death”

North American patients say:

• Dying in ones sleep

• Dying quietly

• Dying with dignity

• Being pain free

• Dying suddenly

North American Doctors say:

• symptom control (pain control)

• Family involvement

• Peacefulness

• Freedom from distress

What is a bad death?

North American doctors say:

• uncontrolled symptoms (pain)

• Lack of acceptance

• Being young

Hirai et al (2006) - Methods

Qualitative interviews w/ non-medical and medical personale: n = 63 total

• cancer patients (n = 13)

• Family members (n = 10)

• Doctors (n = 20)

• Nurses (n = 20)

Obtained from five cancer institutes in japan

Hirai et al (2006) - Patient selection criteria

Incurable advanced cancer

Knew about their diagnosis

Not cognitively impaired

Between the ages of 20-80

Hirai et al (2006) - Doctor/Nurse selection criteria

More than 2 years of clinical experience in cancer treatment

Hirai et al (2006) - Open-ended questions

Medical and non-medical staff were asked:

• examples: for patients

  • “If your disease was incurable what would be the best thing you could do?”

  • “If you were dying, what would be the best thing you could do?”

Hirai et al (2006) - Conclusion

A good death in japan was found to share many common attributes with a good death in western countries

The purpose of the study was to compare east and west cultural views on a good death

Duggleby, Degner et al. (2007) - Hope intervention study - Purpose

To determin the effectiveness of living with hope program (LWHP) in increasing hope and quality of life in older, terminally ill cancer patients