Health-Sci 1111A Midterm

Evidence-based

-systematic research

-empirical data

-peer review

-replicability

-consensus within scientific community

Evidence based does NOT mean evidence-informed

Science literacy

1. engage with scientific concepts, principles, and info effectively

2. ability to comprehend, evaluate, and apply scientific info in various aspect of life

Why is science and scientific data important

-informed decision making

-health and wellness

-public policy

-global challenges

Science IS vs IS NOT

IS:

-a process

-acquire and update knowledge

-open to new evidence

-self-correcting

-slow

IS NOT:

-body of knowledge

-system of beliefs

-institution or individual

-list of facts

-easy

Science Vs. Pseudoscience

-science uses credible and reputable sources

-science uses citations (peer-reviewed sources)

-science does not use misleading visuals

Strategies to spread misinfo for pseudoscience

-sensationalism

-impersonation

-emotion

-polarization

-conspiracy

-discredit

-trolling

advantages of anxious behavior

• In a low danger, nutrient rich environment • Calm rat does well, reaches high social standing, doesn't worry about meals • Anxious rat has low social standing, suffers from chronic diseases • In a high danger environment • Anxious guarded rat will do well because will respond quickly to stress, and keep a low profile • Calm rat may be too relaxed and could get eaten by predatory

Epigenetic Patterns

• Gives genome flexibility beyond fixed DNA code

• Allows certain information to be passed to offspring

• Sensitive to changing environmental conditions

•Reversible

Early Life Stressors

-negative experiences or events during childhood

-impacts on physical, emotional, and psychological well being

Types of developmental windows

Critical window:

-Periods of development when certain experiences or inputs are crucial for normal development

-During this period specific biological processes occur such as development of neural circuits or maturation of certain brain areas If missed, can result in permanent deficits or difficulties in an area of development

Sensitive Window:

Periods of increased susceptibility or heightened sensitivity to experiences or influences,

-not as rigidly defined as critical windows (more flexible) ----Influenced by environmental or experiential factors (e.g. social support or enriching experiences)

- If missed, missed opportunities for optimal development

Types of impacts on wellbeing (early life stresors)

• Mental Health Issues

• Anxiety, depression, suicide, eating disorders, self-harm suicide, personality disorders

• High risk behaviours • Substance abuse, promiscuity, teen pregnancy, and impulsive behaviour

• Cognitive Impairment • Attachment Issues

• Difficulty trusting others

Adverse Childhood Experiences (ACEs) Study

• Objective: Examine relationship between adverse childhood experiences and mental health issues later in life •

Methods: • 17,000 adults in San Diego, California • Questionnaire with 10 categories of ACEs HS1111: Health and Wellness: Exploring the Evidence on How to Achieve a Balanced, and Meaningful Life Dr. Anushka Ataullahjan •

Findings: • High prevalence of ACEs, with many reporting more than one experience during childhood • Risk of range of negative health and social outcomes • More ACEs the more likely a negative impact

Impact of the ACEs Study

• Awareness of long-term impacts of childhood trauma

• Implications for policymakers in influencing policies, programs, and interventions

What is toxic stress?

Intense and prolonged adversity without support

Intergenerational Impacts with stress

• Transmission of Stress Across Generations

• Ability to Nurture Offspring

• Epigenetic Changes

Helsinki Birth Cohort

• World War II

• Evactuation of 70,000 children from Finland to foster homes in Denmark and Sweden

• Birth cohort of children born between 1934-1944

Findings:

• Evacuees 20% more likely to be depressed at follow-up • Inter-generational effects among women - daughters of female evacuees four times more likely to be hospitalized for depression

What is Epigenetics?

-Epigenetics refers to the study of heritable changes in gene expression or cellular phenotype that do not involve alterations to the underlying DNA sequence

-Epigenetic changes involve chemical modifications to DNA and associated proteins, such as histones, that act like "tags" or "marks" influencing gene regulation

-These modifications can be passed on to offspring, affecting subsequent generations, but are also reversible and responsive to environmental cues

Role of Epigenetic Modifications

1. Gene Regulation: Epigenetic modifications play a critical role in controlling when and to what extent genes are turned on or off in cells

2. Cell Identity: They help establish and maintain cell identity during development, ensuring different cell types perform distinct functions

3. Environmental Response: Epigenetic changes allow organisms to adapt to environmental factors, making them responsive to diet, stress, toxins, and hormonal signals

4. Imprinting: Epigenetic imprinting leads to genes being expressed differently depending on whether they are inherited from the mother or the father, impacting development and growth

Epigenetics and Mental Health

• Stress and trauma can affect epigenetic markers on genes linked to mental health leading to increased

• Schizophrenia

• Depression

• Bipolar Disorder

• Anxiety Disorders

Lifestyle and epigenetics

-diet and nutrition

-sleep

-exercise

(all effect epigenetics)

Epigenetic Inheritance

• Epigenetic information is carried within gametes (sperm and egg cells) and can affect gene expression in the developing embryo

• Can be reversible or stable across generations

The Dutch Hunger Winter (1944-1945)

• Occurred during World War II in the Netherlands • German blockade led to severe food shortages

• Cut off from supplies due to the war

• Widespread famine affecting millions • Severe malnutrition and starvation

• Unintended human experiment due to unique circumstances

• Natural Experiment

• Unique opportunity to study long-term effects of prenatal malnutrition

• Higher risk of chronic diseases among famine-exposed individuals

• Some second-generation descendants showed increased risk of cardiovascular diseases

Importance of Early Intervention

• Timely and targeted support provided to children facing developmental, emotional, or behavioral challenges

• During critical early years of a child's life

• Aims to address issues before they become more complex • Focuses on holistic development

Bucharest Early Intervention Project

▪ Randomized control trial in an orphanage in Romania ▪

Objective: To examine the long-term effects of severe early deprivation and institutionalization on cognitive, social, and emotional development

▪ Three groups of children: ▪ Non-orphaned children (control) ▪ Children randomized to foster care ▪ Children randomized to remain in orphanage

Findings:

• Impact of Institutionalization

• Benefits of High-Quality Foster Care

• Sensitive Period for Development

Mental Illness Interventions include

• Counselling

• Group Therapy

• Psychotherapy

• Cognitive Behavioural Therapy

• Complementary and alternative therapies

• Psychopharmacology/medication

Large Inequities

• Evidence-base based on high income countries

• Difficulty identifying those in need

• Specifically when considering diagnostic criteria and validity for young children

• Limited skilled human resources

• Expenditure on mental health

Task Shifting

• training of lay workers to deliver community based programs

• increase access to psychosocial support in marginalized and difficult to reach populations

Friendship Bench in Zimbabwe

• Ambuya utano (grandmother health providers)

• Bench located outside health centre

• Community awareness sessions

• Screening, referral, and treatment using problem-solving therapy

Technology-Assisted Cascaded Training and Supervision system' (TACTS) in Pakistan

• Program delivered in Swat

• Use of LHWs to deliver Thinking Healthy Programme

• TACTS allowed remote supervision

• No sig. difference between face-to-face vs. digital supervision

Why are we speaking about this? (inequity and mental health)

• Importance of a life course approach

• And beyond: epigenetic effects?

• Improving mental health extends beyond health sector

• Integration of mental health with primary health care and other sectors

• More investment in mental health

Father of Positive Psychology

Martin Seligman

What is mindset?

Mindset creates meaning systems

Attribution Theory

When you get a poor grade on a quiz, you might blame the teacher for not adequately explaining the material, completely dismissing the fact that you didn't study.

One of the pioneers of mindset research

Carol Dweck: Carol Dweck is the Lewis and Virginia Eaton Professor of Psychology at Stanford University and one of the world's leading researchers on motivation and mindsets. Her work focuses on why people succeed and how it is possible to foster their success.

ERP Evidence for How Mindsets Control Attention

1. Participants asked a question. 2. Participants type their answer. 3. Participants are told whether they are right or wrong. 4. Brain activation is recorded. 5. Participants are told the correct answer. 6. Brain activation is recorded.

Growth mindset is not always positive

• Not everything can or should be changed

• Can cultivate negative emotions

• Blame

• Pressure to succeed

How Do Everyday Interactions Shape Mindsets?

• The language we use tells others what we believe and what we value

• Feedback tells us what is expected of us and what goals we should have

Person praise vs. process praise

• Person praise linked to fixed mindset

• Process praise can cultivate growth mindset

Praise Effects on IQ Test Performance:

• Control Group "Wow, that's a really good score."

• Intelligence Praise "Wow, that's a really good score. You must be smart at this."

• Effort (Process) Praise "Wow, that's a really good score. You must have tried really hard."

Considerations with growth mindset interventions

• Interventions are difficult to create

• Mindset Environment

• Need for environments that foster growth mindset

• Interdisciplinary collaboration

False growth mindset

Growth mindset does not equal effort. Need good strategy and mentorship

Believing in the potential for people to change

• Study by Yeager et al, 2011

• 202 Finnish students in Grades 9 and 10

• Participants in incremental group read article about how people can change using example of an individual who was a bully

• Participants in control group read article about someone being bullied

Results:

• Learning about how people can change

• reduced desire for vengeance

• Less likely to believe in bad person attributes

• Reduced feelings of hatred

• Reduced feelings of shame

Neurological Nihilism

• Used to believe that brain only developed in childhood • And then later declined in later life \

• Brain cells failed to developed properly, were injured or died couldn't be replaced

• Brain could not alter its structure and find a new way to function if part of it was damaged

• Brain conditions could not be treated

Late 1960's/early 1970s (brain)

• Evidence that brain changed structure with different activities

• Increased circuits

• Pushed back against idea of brain as a hardwired machine

Discovery of neurogenesis

• Birth of new neurons and glial cells in the adult human brain

• Process through

• Synapse formation and elimination

• Axonal sprouting

• Pruning

2 Types Of Brain Plasticity

1. Structural plasticity: experience/memories change brain's physical structure

2. Functional Plasticity: brain functions move from damaged area to undamaged area

Neuroplasticity

Brain's ability to change and adapt

The Hebbian Principle

neurons that fire together, wire together.

Brain hemispheric Communication

Cross-lateral training

Genetics (Early Brain Development)

• Determine the basic structure and functioning of the brain

• Susceptibility to certain conditions or disorders

Learning Environments (Early Brain development)

Wide range of sensory and motor experiences can produce long lasting changes

• Same experience can alter brain differently at different ages

• Early sensory and motor experiences can have impacts on brain during development and adulthood

Psychoactive Drugs (early brain development)

• Psychoactive drugs, including prescription drugs, can have large impacts on brain development

• Prenatal or postnatal exposure can have impacts

Early Stress

• Gestational and infant stress can cause plastic changes in synaptic organization of brain

• Limited evidence also suggests that postnatal stress through maternal separation on synaptic organization in adult brains

• Timing of prenatal stress also is important

Parent and Child Relationships (early stress)

• Evidence suggests maternal-infant relationships can initiate long term developmental effects that persist into adulthood • Enhanced maternal care in first week of life caused changes in signally pathways in hypothalamus and amygdala • Evidence that can influence development of hypothalamic-adrenal stress response

Peer relationships (early stress)

• Play behaviour plays an important role

• Abnormalities in play behaviour may influence prefrontal development and later adult behaviour

Intestinal Flora

• Microbiome (i.e. gut microbiota) may play a role in signalling pathways, neurotransmitter turnover, and production of synaptic related proteins

• Infections during development may impact brain development, with impact into adulthood

Early development crucial lifestyle activities

physical activity, sleep, nutrition

Neuroplasticity for healing

• Examples of individuals with brain damage healing because of new neural connections

• Stroke recovery

• Traumatic brain injury

• Neurodegenerative disease

Constraint Induced movement therapy

Neuroplasticity-based intervention for stroke recovery

Maladaptive neuroplasticity

• Chronic Pain

• Post-traumatic Stress Disorder

• Addiction

• Obsessive compulsive disorder

Phantom Limbs: Maladaptive plasticity

• Phenomenon where an individual feels pain in a limb that has been amputated

• Difficulty getting relief from pain

• Experienced by 60-80% of amputees

• Phenomenon explained by neuroplasticity

• cortical maps of limbs are still engaged

• area of cortex being activated misinterpreted as activation of limb

Mirror Therapy for Phantom Limb Pain

-brain receives feedback that other hand is moving when they move good hand

-neural remapping

Mental Health Interventions Contribute to Neuroplasticity

• Cognitive behavioural therapy

• Mindfulness-based interventions

London Taxi Drivers

• 16 right-handed male London taxi drivers • average of 2 years of experience

• 50 right-handed male control subjects • no experience as taxi drivers

• Structural MRI scanning

• Voxel-based morphometry

Results:

• Increased grey matter in the hippocampus among the taxi drivers

• Correlation between experience and grey matter volume

Follow Up Study:

• 79 Trainee taxi drivers in London • Followed up after 3-4 years when completed training (included learning London streets) • Tested brain function and memory of trainees • Before and after training • 39 qualified • Those who qualified had • Increased gray matter in posterior hippocampus • Changes to memory profile • No structural brain changes were observed in trainees who failed to qualify or control participants

Music and Neuroplasticity

• Music Triggers Brain Changes: • Extensive neuroimaging studies show structural and functional brain changes due to music

• Clinical and Therapeutic Applications: • Music's potential in slowing age-related cognitive decline, brain damage and psychiatric conditions • Encourages cortical remapping for motor control • Music therapy boosts dopamine release • Enhances motivation, rewardseeking, and learning

Music Therapy and Traumatic Brain Injury

• 40 Traumatic Brain Injury Patients • Experienced amnesia, and cognitive impairment • Randomized Control Trial • First three months • Group 1: Neurological music therapy with standard care • Group 2: Standard care • Next three months • Group 1: Standard care • Group 2: Neurological music therapy with standard care • Behavioural Tests and MRIs at baseline, 3-months, and 6 months

Results:

• Improved executive functioning during intervention • Positive effect endured over the follow-up period • Improved set shifting during intervention • Did not last through the follow up period

Musicians and Neuroplasticity

• Increased grey matter

• Improved cognitive function

• Enhanced motor function

• Increased emotional regulation

• Greater neural efficiency

How to train our brains

• Encoding leads to consolidation

• Activation leads to installation

• State leads to trait

experience doesn't equal learning

Two Steps of training our brain

1. Must experience what we want to develop

2. Must help that experience lead to lasting physical change in body, specifically brain

HEAL

• Developed by Dr. Rick Hanson

1. Have a beneficial experience: Notice it or create it. Installation

2. Enrich it: Stay with it, feeling it fully.

3. Absorb it: Receive it into yourself.

4. Link it: Use it to soothe and replace painful, harmful psychological material.

• If we have more experiences of joy, we will become more joyful • If we engage in more mindfulness, we will become more mindful

Meditation and Neuroplasticity

Methods • 20 experienced meditation practitioners • 15 controls with no meditation or yoga experience • MRI used to visualize cortical thickness

Results:

• Meditation practitioners showed thicker cortical regions associated with sensory, cognitive, and emotional processing • Meditation appeared to slow age-related cortical thinning

Jill Bolte Taylor

Brain researcher Jill Bolte Taylor studied her own stroke as it happened -- and has become a powerful voice for how we can choose to replace our stress, fear and anxiety with feelings of joy and deep inner peace.

What is resilience?

• Multiple definitions

• Overcoming negative effects of risk exposure, adapting or coping successfully with traumatic experiences, and avoiding negative trajectories associated with risk

-Resilience is a process not a static trait

• Content Specific

• Culture Specific

-Age of exposure is important!

Promotive and protective factors and processes (PPFPs) (resilience)

-Promotive and protective factors and processes (PPFPs)

-resilience is facilitated by multiple PPFPs at multiple system levels

Promotive Factors and Processes

• Promotive factors are characteristics, conditions, or resources that actively enhance or facilitate positive development and well-beingExamples Access to quality education

• Promotive processes refer to the actions, behaviors, or strategies that individuals or communities engage in to promote positive outcomes and strengths Examples: Goal-setting, Commitment to studying and learning

Protective Factors and Processes:

• Protective factors are factors that act as a buffer or shield against the development of negative outcomes or risks Example: Strong social support

• Protective processes refer to the actions, behaviors, or strategies that individuals or communities use to reduce or mitigate the impact of adverse situations or stressors. Example: Help seeking

Assets

reside within the individual, such as competence, coping skills, and self-efficacy

Resources

• include parental support, adult mentoring, or community organizations that promote positive youth development

Categories of resilience models

1. Compensatory 2. Protective 3. Challenge

Compensatory resilience model

• where a resilience factor counteracts a risk factor

• has a direct effect on the outcome

• one that is independent of the effect of the risk factor

Protective resilience model

• Assets or resources influence or reduce the effects of a risk on a negative outcome

• Protective factors may neutralize the effects of risks, weaken, but not completely remove them, or enhance the positive effect of another promotive factor in producing an outcome

Challenge resilience model

• exposures to both low and high levels of a risk factor are associated with negative outcomes, but moderate levels of the risk are related to less negative (or positive) outcomes.

Afghanistan resilience

• In 2006 • school-based health survey of 11-16year old students and their caregivers in the central and northern municipalities of Kabul, Bamyan, and Mazar-e-Sharif• Schools were the best point of contact for drawing a community-level sample • access to both female/male participants and a safe environment

Findings:

• 5% of adults and10% of children cited no major worries in life

Helsinki Birth Cohort Study

Acknowledging the interactions between early growth and genotypes might help us designing individual therapies as well as planning dietary and exercise interventions for high risk groups. These interventions need to take into account individual variability not only in genetic setup but also in early patterns of growth. Small body size at birth associated with CVD and type 2 diabetes.

Mindsets: Investigating resilience AnnaMaria Boullion

The results of this study suggest that a growth mindset may be an important facet of resilience when individuals have experienced any type of childhood maltreatment but especially emotional abuse and emotional neglect.

DALY

years of life lost due to a disability or condition of some sort

diagnostic overshadowing

two conditions and your symptoms can chalk up to only one

iatrogenesis

disease or illness is caused by errors in diagnosis and med examination

multisectoral action

solving large inequalities in mental health treatment

Nature Vs Nurture

Nature: genetic changes

Nurture: epigenetic changes

Dunning-Kruger effect

when we have low knowledge of something we think we know it all but we don't

Current Theories of Wellbeing

Hedonic (satisfaction) and Eudaimonic (fulfilment with life)

Hedonic views

subjective wellbeing:

• Personal evaluations of your own life satisfaction and experiences

Components of Diener's model:

• frequent positive affect • infrequent negative affect • cognitive evaluations such as life satisfaction

Eudaimonic views

Flourishing "to grow" or "to " prosper" state of optimal psychological and emotional well-being

Seligman's The PERMA Model

P: positive emotions

E: engagement

R: positive relationships

M: meaning

A:accomplishment

Ryff's Six Factor Model of Psychological Well-Being

1. Autonomy

2. Environmental Mastery

3. Personal Growth

4. Positive Relations with Others

5. Purpose in Life

6. Self-acceptance

Time keeping

First Record of Timekeeping: 18000-8000 BCE

How much time do we think we have? 4000 weeks

Earliest Sundial: 1500 BC

Accuracy of Time Keeping Increased

• Relationship with time started to change and evolve as well

Is time a dimension of health inequality?

• Influenced by the work of Dr. Lyndall Strazdins

• Health is shaped by social structures

• Social differentiation can lead to health inequalities

• How does time structure access to resources?

Attention Management

Getting things done at the right time when you're motivated to do so

• Limiting distraction

Goal shielding theory

• Protecting one's focus on a goal by not allowing yourself to get distracted by other goals

• Goals compete for attentional resources

• Unattained goals stay on your mind